The Office of Personnel Management issued its annual call letter for benefit/rate proposals for Federal Employee Health Benefits programs. This annual letter outlines policy goals and initiatives for FEHBP for 2019. The letter provides an idea for FEHB participants to changes that may begin in 2019.
One emphasis in the coming year is quality and affordable health insurance coverage for federal employees. The call letter states:
“OPM has developed an agency strategic objective to improve the quality of healthcare received by enrollees in FEHB plans, increase the affordability of FEHB plans, and enhance the portfolio of available FEHB plans to increase the proportion that offer high quality at an affordable cost. In alignment with this strategy, this year’s call letter focuses on topics that we believe will keep the FEHBP on a path of innovation, quality, and affordability well into the next decade.”
To meet their objective, OPM is suggesting health insurance companies in FEHB consider the following:
- Changing cost sharing for high value and low-value benefits to help ensure members are getting the most value for their healthcare dollar.
- Implementing high-performance tiered provider networks that offer reduced cost-sharing for members who choose a provider from such a network.
- Reducing cost sharing when members act to manage chronic conditions or obtain higher quality or more efficient care through provider partnerships.
- Improving enrollee engagement and decision support through online portals.
- Exploring innovative models that include other cost management techniques.
OPM noted that “In 2016, 26.2% of total FEHB expenditures were on prescription medications”. While that’s a major expense, this call letter states, “studies have shown that approximately 50% of medications for chronic disease aren’t taken as prescribed”.
OPM is asking health companies in FEHB to find ways to make better use of prescribed drugs including making sure people are adhering to how the medicine is supposed to be used to be effective.
The agency is also asking carriers to “review their contracts and require that members are charged the lesser of the prescription price or applicable copayment amount for prescription medicines.”
The intended result is to provide quicker turnaround time and to reduce the number of prescription abandonment rates.
OPM also thinks better technology, like electronic prior authorizations, may also help by cutting down the time providers spend to exchange clinical information with their patients.
The call letter says there are many items that must be included in the 2019 health plans for FEHB on the opioid epidemic. Items include ways to reduce the number of prescriptions for opioids when other alternatives may be available.
More emphasis on rehabilitation programs will also be available. A new system is now in place for tracking opioid use from multiple providers as well as data on prescriptions and addiction to these medications.
Genetic testing has become more relevant lately, so FEHB participants may start seeing significant changes in this area in 2019. OPM avoided saying what FEHB plans should include regarding genetic testing. Instead, they wrote:
“We strongly encourage FEHB carriers to review their current benefits and propose any needed revisions for 2019. All proposals should include a description of the carriers’ genetic testing strategy, the scope of included testing, and any applicable vendor partnerships.”
This letter provides some useful information on FEHB plans in 2019. Be sure to take the time to review it.