OPM puts weight behind e-health
Agency uses its buying power to push private health plans that serve the government workforce
Federal employees have the opportunity to take advantage of electronic personal health records and other health information technology that let them take more control of their health care that is enjoyed by few employees in the private sector.
That’s because the Office of Personnel Management made health IT and cost transparency — in which information on health costs is published online — key provisions of the Federal Employees Health Benefits Program.
The emphasis on health IT stems from a presidential executive order issued in August 2006 to promote quality and efficient health care in government. The Office of Management and Budget also incorporated health care into the President’s Management Agenda, requiring agencies that administer or sponsor health care to improve the quality and efficiency of their systems.
OPM pushes out health IT benefits, along with its other health benefits and services, through partnerships with private health plans, said Dan Green, OPM’s deputy associate director for employee and family support policy in the Strategic Human Resources Policy Division.
OPM contracts with private-sector health plans for employer-sponsored health coverage for 8 million civilian employees and their families. Those participating health plans in turn contract with medical providers who provide the benefits and services for federal enrollees, Green said. OPM leads by pushing requirements out through these layers.
“The rubber hits the road at the provider level,” he said.
OPM also relies on constant communications with its business partners and details its expectations for their progress in health IT, cost transparency and other benefits in annual program letters to carriers. OPM makes those letters available online, and it also posts insurance plans’ health IT progress and their costs for common conditions on the agency’s Web site.
Last year, OPM required its carriers to begin reporting progress on providing health information technology, their personal health record adoption, and their quality and cost transparency initiatives. OPM will update that report later this fall, Green said.
“The use of PHRs isn’t yet where we’d like to see it and where the capacity is,” Green said. “It will take more education of employees.”
OPM also requires carriers to protect personally identifiable health information as required by the Health Insurance Portability and Accountability Act and the agency’s contract language, he said.
“The challenge of pushing out health information technology while protecting individuals’ medical privacy is a challenge,” Green said. Health IT as differentiator
Leadership from senior executives added heft to the agency’s health IT plans when OPM initiated its effort, he said. Linda Springer, who was then OPM’s director, met with the presidents of the largest insurance companies participating in the Federal Employee Health Benefits (FEHB) plans and sought their involvement with increasing pricing and quality transparency for federal employee members.
“It certainly got the attention of our carriers,” Green said. The companies provided materials of what they had accomplished, but Springer asked them to do more.
“We think our members have access to more information that allows them to be better consumers of health care and which gives them better control over their own health care management,” he said.
In 2007, OPM was the first agency in which its insurance carriers were required to comply with interoperability standards as they are developed for electronic health records. OPM has created an environment among the FEHB carriers to compete for enrollment based on the maturity of their health IT systems and their cost and quality transparency tools, he said.
“We publish on our Web site the carriers who are gold stars in cost and price transparency or implementing health IT and promoting use of that with members and their providers,” he said. “We encourage federal employees to take that into account when they’re choosing a health plan.”
OPM also emphasizes that during open season, which occurs during the last half of November and first two weeks in December, when federal employees have the opportunity to switch their health plans, Green said.
One of the insurance plans working with the federal government is Blue Cross Blue Shield Association’s Federal Employee Program. The FEP’s broad objectives start from OPM, including expanding the reach of health IT initiatives to medical providers and members, said Jena Estes, vice president of the program.
OPM each year issues a set of goals and cornerstones. They then outline the objectives that plans should achieve for the coming year.
“They work very closely with each carrier in implementing programs and initiatives that would support those goals,” Estes said. “We have a strong working relationship with OPM, so we are able to identify opportunities to build programs that meet their goals as well as that align” with Blue Cross Blue Shield.Standards, privacy give pause
Health IT adoption, however, is a challenge, she said.
“It’s sometimes difficult to get the member actively engaged so they want to use the tools, and for providers, it’s a cost factor,” Estes said. Concerns about privacy of health information can also contribute to the hesitancy of members to adopt health IT.
More work must be done to develop and enforce interoperability standards and privacy protections, she said. “That’s what the government’s role is.”
At the same time, standards and privacy protections shouldn’t restrict the flow of information from those who need it for health operations and quality measures, she said.
OPM’s health IT, quality and cost transparency efforts are a model for public and private organizations, said Patricia McGinnis, president of the Council for Excellence in Government.
The council found in its research about health care reform that employees want more and better information about the costs of services, what they will have to pay out of pocket, and the performance of physicians and hospitals so they can make informed choices about their health care, she said.
OPM has noted anecdotally more interest by federal employees in personal health record applications, Green said.
“Some early versions were kind of clunky and difficult to navigate,” he said. Carriers are doing a better job, but it will be a long process.
“Carriers that have the most effective, easiest to use and easiest to understand marketing tools, PHRs and Web sites for comparing and looking for quality — those are the ones who will be most successful with federal employees,” Green said.What’s to come
Meanwhile, OPM has learned from individual federal employees that more are looking online to get information about their health condition, and the agency’s health program is trying to meet that need.
“They still know and trust their doctors, but they want to do their own research,” he said. “They want to go in there armed.” They also are downloading their health history and list of medicines before they go to their physician appointments so they are prepared to fill out forms.
According to its program carrier letter for 2009, OPM will recognize and reward plans that:
- Educate consumers to the value of health IT.
- Provide members with PHRs populated with information from their medical claims, lab test results and medication history.
- Meet OPM’s health care cost and transparency standards.
- Provide incentives for e-prescribing.
- Ensure compliance with federal privacy protections as sensitive health data.
For its part, Blue Cross Blue Shield’s FEP will introduce an improved version of its online health risk assessment, which will encourage members to answer health and behavioral questions and then automatically receive an assessment, Estes said.
“The assessment becomes a tool and framework for engaging with their providers…and becoming more engaged in managing their health,” she said.