Issue Briefs

Following are key portions of a new report by the inspector general’s office at OPM warning that FEHB enrollees are adding to their health risks by deferring preventive care services due to the pandemic.


Executive Summary

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In this Data Brief, we present concerns with downward trends related to preventive care services utilized by a selected section of FEHBP participants during the Coronavirus Disease 2019 (COVID-19) pandemic. Specifically, this brief focuses on claims incurred and paid during the period of January through August of 2020 and compares this data to the same time period in 2019.

The Data Brief offers the U.S. Office of Personnel Management (OPM) and the FEHBP participating health insurance carriers insight into how COVID-19 is impacting a large portion of the FEHBP population and will, hopefully, encourage discussions regarding actions that may need to be considered to offset the potential impact to the program and its members.

Our objective was to analyze trends in the health insurance claims data for the FEHBP over time throughout the COVID-19 pandemic.

Key Takeaways:

Federal Employees Health Benefit Program (FEHBP) members’ utilization of preventive care services has significantly decreased during the COVID-19 pandemic.

Annual Wellness Visits fell 18.6%

Colonoscopies fell 32.2%

Mammograms fell 23.8%

Pediatric Immunizations fell 16.2%

Prostate Exams fell 16.8%

Women’s Preventive Exams fell 36.2%

This significant decrease in preventive care services could have potential cost and participant health ramifications for the program should these trends not recover in the coming months.

As the largest employer-sponsored group health insurance program in the world, with over 8 million enrollees, the FEHBP provides coverage for a wide range of preventive care services, at no cost share for the enrollee, for both adults (22 years of age and over) and children (under 22 years of age). Preventive services for adults include physical/well visits, colonoscopies, Prostate Specific Antigen tests, screening mammograms, cervical exams, and Sexually Transmitted Infection (STI) screenings, among others. Some of the preventive services covered for children include healthy newborn visits and screenings, hearing and vision screenings, STI screenings, and cervical exams. The program also covers a wide array of vaccinations for both adults and children . . .

. . . we observed steep declines in preventive health care across a range of services in March and April 2020. While the claims for these services rebounded somewhat starting in May 2020, our most recent data available shows preventive services trending down beginning in July and continuing into August. It is too early to tell how a potential surge in COVID-19 cases heading into autumn and winter may affect future utilization, but the current direction is concerning . . .

. . . Our analysis also identified downward trends in mammograms . . . for the plans we analyzed, the number of covered individuals increased by 1.54 percent from 2019 to 2020. While the increase in specific procedures will depend on the demographics of the subscribers from year to year, procedures should generally increase in line with the increase in subscribers. However, this was not the case for mammograms, which saw an average decrease of 23 percent per month in 2020, as opposed to the 1-2 percent increase that would be expected . . . Given the decrease in mammograms performed through August for these two carriers alone, the FEHBP could see an increased mortality of about 75 individuals, and this number could increase even more if these trends do not change . . .

. . . Additionally, we have seen reductions in the number of childhood immunizations performed during the pandemic. While the rate has been rising again since April, it still has not met the average rate for August from the past three years, despite a greater number of enrolled individuals . . . it is important to remember that because of the significant drops in the spring, we would need to be seeing drastically higher rates of vaccinations in the second half of the year to make up for those missed earlier in the year . . .

Conclusion

As can be seen from our claims analysis results, FEHBP members’ utilization of preventive care services has significantly decreased throughout the COVID-19 pandemic. Though utilization for some of these services appears to be rebounding since June, utilization rates have not returned to levels seen in previous years for many types of services and are not close to the utilization levels that would be needed to make up for the services missed earlier in the year. Given the many benefits of regular preventive care, we have concerns about the effect of these trends on the health of the FEHBP population, as well as on the health care system as a whole. As stated in our Executive Summary, it is hoped that this brief will encourage discussions between OPM and the program’s participating carriers regarding actions that may need to be considered to offset the potential impact to the program and its members.

OPM’s Response

Impacts of the pandemic have been felt in almost every segment of society and the FEHB is no exception. As some physician offices closed and some hospitals limited elective care, it was no surprise to see preventive claims and utilization decrease.

In response to these trends, FEHB Carriers have initiated reminders to members on the importance of resuming and maintaining key health screenings and treatments. Various OPM program offices and the Carriers themselves have also been actively engaged in surveying, analyzing, monitoring, communicating, and planning appropriate actions. Work continues in this rapidly changing environment and will necessitate flexible solutions based on many factors, which could recharacterize or even render moot formally documented plans.

While we recognize OIG’s thoughtful research and value their partnership, we would like OIG to expand its analysis to other carriers. While the carriers selected for this analysis represent a large share of the FEHBP population, they are only 2 of the more than 80 carrier contracts in the FEHBP. We also seek the opportunity to review the data behind OIG’s analysis to help direct the Contracting Office’s future actions in providing access to relevant benefits and protecting FEHBP members.

Finally, while OPM is acting in each area covered by the above recommendations, their broad nature does not lend themselves to formal responses. As stated above, potential actions are fluid based upon fluctuating circumstances. Upon issuance of the Final Data Brief, OPM’s Healthcare and Insurance office will provide periodic oral updates on the agency’s efforts as OIG has agreed would be appropriate in response to this evaluation.

OPM is fully committed to positioning the FEHB Program to help members combat COVID-19 with information and access to treatments as they become available.”

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