OPM urges FEHBP carriers to find new ways to cut health care costs for 2019

The Office of Personnel Management is encouraging Federal Employee Health Benefits Program (FEHBP) carriers to find new ways to cut their costs for the next year.

“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,” Alan Spielman, director of health care and insurance for OPM, wrote in a Jan. 23 letter to insurance carriers.

These letters typically establish the general guidelines and policy goals that OPM has for its health insurance program for each upcoming year.

For 2019, OPM wants FEHB carriers to consider how they could change existing plans or introduce completely new plan options. Specifically, OPM suggests:

  • Changing cost sharing for high-value and low-value benefits to ensure participants are getting the best value for their money,
  • Implementing high-performance tiered provider networks that offer reduced cost sharing for participants who choose to participate in that kind of network,
  • Cutting cost sharing when participants manage chronic conditions or use creative providers and partnerships to get more efficient health care,
  • Using online portals to communicate and engage with participants, and
  • Consider “innovative models” or evidence-based management tools.

FEHB premiums have steadily increased for the past several years. Non-postal employees and annuitants enrolled in the Federal Employee Health Benefits Program are paying, on average, 6.1 percent more toward their premiums this year. Premiums rose an average of 6.2 percent for participants in 2017, and enrollees saw a 6.4 percent increase in 2016.

OPM has long sought cost-savings from its FEHB carriers, particularly as the health care plan’s enrolled population grows older. Former OPM Director Katherine Archuleta similarly called on FEHB carriers in 2014 to find ways to keep health care costs low, but the agency’s 2018 letter mentions a specific “agency strategy” that balances “innovation, quality and affordability well into the next decade.”

Beyond its call for cost savings, OPM is also encouraging its FEHB carriers to continue addressing the opioid epidemic, which the Trump administration officially declared a national public health emergency back in October.

Doctors overall are prescribing fewer and smaller opioid doses to FEHBP participants, according to OPM’s preliminary data on the Federal Employee Health Benefits Program, but the agency is asking carriers to do more. Specifically, OPM wants carriers to detail how their providers are making the public aware of opioid risks and what doctors are doing to explore alternative pain treatments.

In addition, OPM is encouraging FEHB carriers to consider how they can keep prescription drug costs low.

Prescription drugs accounted for 26 percent of FEHBP costs in 2016, according to OPM, and more program participants use more specialty medications and drugs each year.

“To ensure members have access to affordable medications, OPM strongly encourages FEHB carriers to review their contracts and require that members are charged the lesser of the prescription price or applicable copayment amount for prescription medication,” Spielman wrote.

Other changes could also lead to lower drug costs, OPM said. The agency suggested carriers focus more intently on medication management programs to ensure that FEHBP participants are following a regimen and taking drugs as prescribed.

Better technology, such as electronic prior authorizations, may also help. E-authorizations could cut down the time providers spend to exchange clinical information with their patients, OPM said.