Federal Employees Health Benefits Program: First-Year Experience with High-Deductible Health Plans and Health Savings Accounts
Published: 2006-01-31T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: The Federal Employees Health Benefits Program (FEHBP) recently began offering high-deductible health plans (HDHP) coupled with tax-advantaged health savings accounts (HSA) that enrollees use to pay for health care. Unused HSA balances may accumulate for future use, providing enrollees an incentive to purchase health care prudently. The plans also provide decision support tools to help enrollees make purchase decisions, including health care quality and cost information. Concerns have been expressed that HDHPs coupled with HSAs may attract younger, healthier, or wealthier enrollees, leaving older, less healthy enrollees to drive up costs in traditional plans. Because the plans are new, there is also interest in the plan features and the decision support tools they provide to enrollees. GAO was asked to evaluate the experience of the 14 HDHPs coupled with an HSA that were first offered under the FEHBP in January 2005. GAO compared the characteristics of enrollees in the 14 HDHPs to those of enrollees in another recently introduced (new) plan without a high deductible and to all FEHBP plans. GAO also compared characteristics of the three largest HDHPs to traditional FEHBP plans offered by the same insurance carriers, and summarized the information contained in the decision support tools made available to enrollees by these three plans.
section_title: What GAO Found
paragraphs: FEHBP HDHP enrollees were younger and earned higher federal salaries than other FEHBP enrollees. The average age of HDHP enrollees (46) was similar to that of the other new plan (47) and younger than that of all FEHBP enrollees (59). These differences were largely due to a smaller share of retirees enrolling in the HDHPs and the other new plan. HDHP enrollees earned higher federal salaries compared to other enrollees. Forty-three percent of HDHP enrollees actively employed by the federal government earned federal salaries of $75,000 or more, compared to 14 percent in the other new plan and 23 percent among all FEHBP plans. In addition, nonretired HDHP enrollees were more likely to be male and to select individual rather than family plans. The three largest FEHBP HDHPs generally covered the same range of services--including preventive services--as their traditional plan counterparts; however, enrollees' financial responsibilities usually differed. Compared to the traditional plans, the HDHPs had higher deductibles. HDHP cost sharing was the same or lower for preventive services and prescription drugs, and all plans covered preventive services before the deductible. Prescription drugs in the HDHPs were subject to the deductible, while they were generally exempt from the deductible in the traditional plans. HDHP cost sharing varied with respect to nonpreventive physician office visits and inpatient hospital stays. Two of the three HDHPs had higher out-of-pocket spending limits, and HDHP premiums were lower on average than the traditional plans. The extent to which the three largest FEHBP HDHPs made available provider quality and health care cost information was limited and varied. Two of the three plans provided several hospital-specific measures of quality on their Web sites, including the volumes of procedures provided by the hospitals and the outcomes of those procedures, and the other plan provided links to other Web sites containing such information. Regarding physician-specific quality data, one plan provided a single measure. One of the plans provided average hospital cost estimates and two provided average physician cost estimates for selected services, but none provided the actual rates an enrollee would pay that the plan had negotiated with providers. Regarding prescription drugs, two of the three plans provided the average retail pharmacy drug costs, but none provided the actual negotiated rates an individual would pay at a particular retail pharmacy. In commenting on a draft of this report, the Office of Personnel Management (OPM) said that it would monitor enrollment trends over time to assess whether certain individuals--such as younger or healthier individuals--disproportionately enroll in HDHPs. OPM also said it would continue to encourage plans to expand the decision support information they provide to enrollees, including the pricing of health care services.

section_title: Letter
paragraphs: The federal government provides health insurance coverage for over   8 million federal employees, retirees, and their family members through  health plans participating in the Federal Employees Health Benefits  Program (FEHBP), the largest employer-based health insurance program  in the country. Similar to many large employers, the FEHBP has recently  begun offering a type of “consumer-directed health plan” (CDHP) that  combines a high-deductible health plan (HDHP) with a tax-advantaged  health savings account (HSA) that enrollees use to pay for a portion of  their health expenses. (Throughout this report we refer to the FEHBP  plans that are coupled with HSAs as HDHPs.) The higher deductibles  typically result in lower premiums because the enrollee bears a greater  share of the initial costs of care. The HDHPs provide decision support  tools to help enrollees become more actively involved in making health  care purchase decisions, such as information about the quality of health  care providers and the cost of health care services.
Proponents believe that HDHPs coupled with HSAs can help restrain  health care spending. They believe enrollees have an incentive to seek  lower-cost health care services, and to only obtain care when necessary  because account funds can accrue from year to year. Enrollees may use  these funds to pay for health care in subsequent years or for other  purposes, such as retirement. However, some believe that these plans will  attract a disproportionate share of wealthier enrollees who seek to use the  HSA as a tax-advantaged savings vehicle. Some also express concern that  HDHPs may disproportionately attract younger and healthier enrollees. If  this occurred to a large extent, premiums for traditional plans could rise  due to a disproportionate share of older and less healthy enrollees with  higher health care expenses remaining in the traditional plans. Because  HDHPs coupled with HSAs are a relatively new concept in health care  benefits plan design, there is also interest in how the plans’ features  compare to traditional plans and the extent to which the plans provide  decision support tools, such as provider quality and cost data, to help  enrollees make informed and prudent health care purchase decisions.
You asked us to evaluate the experience of the HDHPs coupled with HSAs  that were offered under the FEHBP beginning in January 2005. Because  there is limited experience to date with these plans, we limited our review  to the demographic characteristics of the enrollees and key features of the  HDHPs. In particular, we examined (1) characteristics of HDHP enrollees  compared to all FEHBP plan enrollees, (2) features of the HDHPs  compared to traditional FEHBP health plans, and (3) the extent to which  FEHBP HDHPs provide information to enrollees to assist them in making  health care purchase decisions.
To identify the demographic characteristics of HDHP enrollees, we  analyzed FEHBP enrollment data provided by the Office of Personnel  Management (OPM), the federal agency responsible for administering the  FEHBP. We obtained data for each of the 14 HDHPs coupled with HSAs  that was introduced in 2005. To determine how the enrollees in these plans  compared to other FEHBP enrollees, we compared their demographic  characteristics to two groups. First, we compared them to the  characteristics of all FEHBP plan enrollees. Second, because  characteristics of the HDHP enrollees may differ from the typical FEHBP  enrollee primarily because these plans are new, we also compared HDHP  enrollee characteristics to the characteristics of first-year enrollees of  another FEHBP national preferred provider organization (PPO) plan that  was recently introduced. For each group we examined enrollee age,  income, gender, and whether the plan was for an individual or a family.  Because our preliminary analysis found that retirees were much less likely  to enroll in the FEHBP HDHPs and the other new plan, we excluded  retirees from most comparisons to help ensure that differences were  related to the plan design and not to the absence of retirees among the  new plans. Our assessment of the demographic characteristics of HDHP  enrollees reflects only the first year of plan enrollment and thus may not  reflect future enrollment trends. We did not independently verify the data  provided by OPM; however, we performed certain quality checks, such as  determining consistency among the various data sets provided. We also  evaluated information from OPM concerning how data are collected,  stored, and maintained. We determined that the data were adequate for  this report.
To evaluate the features of the HDHPs, we reviewed plan brochures for  the three HDHPs that operated in most or all states and comprised about  96 percent of all FEHBP HDHP enrollment in 2005. Throughout this report  we refer to these plans as multistate HDHPs. We compared key features of  these plans to the features of other plans offered by the same insurance  carrier, which we refer to as the HDHPs’ traditional plan counterparts. We  compared two of the HDHPs to two national PPO plans offered by the  same carriers, and we compared the third HDHP to 22 regional health  maintenance organization (HMO) plans offered by the same carrier. The  features we examined included covered services, coverage of out-of- network providers, deductibles, cost-sharing arrangements, out-of-pocket  spending limits, and premiums.
To evaluate the decision support tools that plans make available to  enrollees, we reviewed the literature and interviewed experts to identify  the information that experts believe is most helpful to consumers in  assessing the quality of health care providers and the costs of health care  services. We then reviewed the decision support tools that the three  multistate HDHPs made available to enrollees on the plan Web sites to  determine whether the information was present, but did not independently  verify the accuracy of the information.
We conducted our work according to generally accepted government  auditing standards from July 2005 through January 2006.
subsections: section_title: Background
paragraphs: CDHPs are relatively new health care benefits plan designs that are  offered in various forms, including that of an HDHP coupled with an HSA.  The FEHBP began to offer CDHPs in 2003 and first offered HDHPs  coupled with HSAs in January 2005.
subsections: section_title: The Consumer-Directed Health Plan Concept
paragraphs: While insurers and employers offer several variants of CDHPs, these plans  generally include three basic precepts—an insurance plan with a high  deductible, a savings account to pay for services under the deductible, and  enrollee decision support tools.
An insurance plan with a high deductible. CDHP deductibles are about  $1,900 on average nationwide for individual coverage and about $3,900 for  family coverage, compared to about $320 and $680, respectively, on  average, for a traditional PPO plan.
A savings account to pay for services under the deductible. These  savings accounts encompass different models, the most prominent being  health reimbursement arrangements (HRA) and HSAs. Both HRAs and  HSAs are tax advantaged, and funds from these accounts may be spent on  qualified medical expenses—such as the plan deductible and payments for  covered and noncovered services. Funds that are used for qualified  medical expenses that are not covered by the health plan do not count  toward meeting the plan’s deductible or out-of-pocket spending limits.
Important distinctions exist between HRAs and HSAs. HRAs are funded  solely by the employer and are generally not portable once the employee  leaves. These funds may accumulate up to any employer-specified  maximums and may only be spent on qualified medical expenses.  Although HRAs are generally coupled with health plans that include a high  deductible, this is not a requirement for favorable tax treatment.
An HSA is a new type of tax-advantaged savings account that, unlike  HRAs, must be coupled with an HDHP that meets statutorily defined  minimum deductibles and limits on out-of-pocket expenditures for  enrollees. Contributions to an HSA may be made by both the employer and  employee. The HSA account holder essentially owns the account and can  transfer funds from one HSA account to another. Funds in these accounts  may earn interest, are allowed to roll over from year to year, and may  accumulate subject only to annual limits on contributions. HSA funds may  also be withdrawn for purposes other than qualified medical expenses  subject to regular taxes and an additional tax penalty, and may be used as  retirement income subject to regular taxes. Certain individuals are not  eligible for HSAs, including those eligible for Medicare or covered by  another health plan in addition to the HDHP.
Decision support tools. CDHPs may provide decision support tools for  consumers to help them become actively engaged in making health care  purchase decisions. These tools may provide enrollees online access to  their savings accounts to help them manage their spending. They may also  provide enrollees with information to assess the quality of health care  providers and the prices for health care services.
While health insurance carriers may provide decision support tools to all  enrollees, these tools may be more important to CDHP enrollees who have  a greater financial incentive to take a more active role in their health care  purchase decisions. To help enrollees choose a doctor or a hospital,  experts suggest they need data to assess the quality of those providers.  Such data may include the volume of procedures provided; the outcomes  of those procedures, such as mortality and complication rates; as well as  certain process indicators, such as the percentage of cases in which a  provider followed established clinical practice guidelines for a particular  procedure. To help enrollees manage their HSA account funds and  evaluate the price competitiveness of various providers, some experts  believe enrollees need information about the expected costs of services— such as an average or expected range of costs for a procedure, or the  actual price a provider will charge based on the payment rates negotiated  between the provider and the health insurance carrier.
Insurance carriers have faced challenges in obtaining or presenting quality  and cost data. For example, experts believe that it may be difficult for  carriers to provide hospital- or physician-specific quality measures  because such measures are not always readily available, particularly for  physicians. They also believe that certain measures can be difficult for  consumers to interpret, such as outcomes measures, and may not  appropriately account for the poorer patient outcomes that may occur  among providers who tend to treat sicker patients. Experts also believe  that insurers have been reluctant to make negotiated provider payment  rates available to consumers due to concerns over future provider  contract negotiations. Therefore, the cost information insurers are willing  to provide is more likely to reflect average rates or a range of costs within  a geographic region rather than the actual negotiated rates.
section_title: FEHBP and Consumer- Directed Health Plans
paragraphs: Federal employees have a choice of multiple health plans offered by  private health insurance carriers participating in the FEHBP, with 19  national plans and more than 200 local plans offered in 2005. Plans vary  in terms of benefit design and premiums. In 2004, nearly 75 percent of  those covered under the FEHBP were enrolled in national plans, with the  remainder in regional or local HMOs. Mirroring the private sector, FEHBP  carriers began offering CDHP options in 2003.
The FEHBP offers two types of CDHPs—high-deductible plans coupled  with an HRA or an HSA. The American Postal Workers Union offered the  first HRA-based option under the FEHBP in 2003. This was followed by  HRA-based plans offered by Aetna and Humana in 2004. In 2005, 14 HDHPs  coupled with HSAs were first offered. As of March 2005, 3,900 individuals  were enrolled in these 14 HDHPs. Including retirees and family members,  about 7,500 individuals were covered by the plans, with nearly all—about  96 percent—in the three multistate plans.
All HDHPs offered by the FEHBP must include certain features. OPM  requires that the plans cover preventive health services before the  deductible has been met. In addition, because OPM is prohibited from  contracting with plans that deny enrollment based on age, all must be  offered with an HRA alternative of equivalent value for those who are  ineligible for an HSA, such as Medicare enrollees. All HSAs and HRAs  must be managed either by the insurance carrier or a trustee—such as a  bank—which has received high ratings from a major financial rating  service. OPM requires all HDHP carriers to offer health care decision  support tools to enrollees. Finally, all HDHPs offered in the FEHBP must  deposit a monthly contribution to the enrollee’s HSA, which is a portion of  the enrollee’s premium payment, called the premium pass through. The  premium pass through can be thought of as a required contribution to an  employee’s HSA, with the remainder of the premium going to the  insurance carrier to pay for the insurance coverage.
section_title: FEHBP HDHP Enrollees Were Generally Younger and Earned Higher Federal Salaries Than Other FEHBP Enrollees
paragraphs: HDHP enrollees were younger, earned higher federal incomes, were more  likely to be male, and were more likely to have individual coverage than  other FEHBP enrollees. The average age of HDHP enrollees was similar to  that of another new plan, but was 13 years younger than that of all FEHBP  enrollees. The share of actively employed enrollees earning federal  incomes of $75,000 or more was 43 percent for HDHPs, compared to   14 percent for the other new plan, and 23 percent for all FEHBP plans.  About 69 percent of HDHP enrollees were male, compared to 59 percent in  both the other new plan and all FEHBP plans, and about 47 percent of  HDHP enrollees had individual coverage, compared to 35 and 37 percent  for the other new plan and all FEHBP enrollees, respectively.
subsections: section_title: HDHP Enrollees Were Younger and Included Fewer Retirees Than Enrollees in All FEHBP Plans
paragraphs: The average age of HDHP enrollees was younger than all FEHBP plan  enrollees, but was similar to that of enrollees in another new FEHBP plan.  The average age of HDHP enrollees was 46, compared to 47 for the other  new plan, and 59 for all FEHBP plans. Differences were largely due to  fewer retirees selecting the HDHPs. Eleven and 18 percent of the HDHP  and other new plan enrollees were retirees, respectively, compared to   45 percent for all FEHBP plan enrollees. Excluding the retirees, the  average age narrowed to 44 for both the HDHP and other new plan  enrollees, and 47 for all FEHBP plan enrollees. (See table 1.)
The distribution of enrollees by age group similarly illustrates the  relatively younger ages of HDHP enrollees and enrollees of the other new  plan. Relative to all FEHBP enrollees, the HDHP and other new plan  enrollees comprise a larger share of enrollees in each age group under 55  years and a smaller share of enrollees in each age group over 64. (See fig.  1.)
section_title: HDHP Enrollees Had Higher Federal Salaries and Were More Likely to Select Individual Plans Than Other FEHBP Enrollees
paragraphs: HDHP enrollees who were actively employed by the federal government  earned higher federal salaries than other active federal employees in the  FEHBP. The share of enrollees earning federal incomes of $75,000 or more  in 2005 was 43 percent for HDHPs, compared to 14 percent for the other  new plan and 23 percent for all FEHBP plans. These differences existed  across all age groups. (See fig. 2.)
Excluding retirees, HDHP enrollees were more likely to be male and to  select individual rather than family plans than were enrollees in other  plans. Sixty-nine percent of HDHP enrollees were male, compared to   59 percent of enrollees in both the other new plan and all FEHBP plans.  Forty-seven percent of HDHP enrollees selected individual plans,  compared to 35 and 37 percent of enrollees in the other new plan and all  FEHBP plans, respectively. (See table 2.)
section_title: FEHBP HDHPs Generally Covered the Same Services as Traditional Plans, but Enrollees’ Financial Responsibilities Usually Differed
paragraphs: HDHPs generally covered the same services as those covered by their  traditional plan counterparts; however, enrollees’ financial responsibilities  usually differed. The FEHBP HDHPs had higher deductibles than their  traditional plan counterparts. In addition, relative to traditional plans,  HDHP cost sharing after the deductible was comparable or lower for  preventive services and prescription drugs. Cost sharing was mixed for  physician office visits and hospital stays—higher than the carriers’  traditional plans in some instances and the same or lower in others. Two  of the HDHPs had higher out-of-pocket spending limits than their  traditional plan counterparts, and in most cases the HDHPs had lower  premiums.
subsections: section_title: FEHBP HDHPs Generally Covered the Same Services as Traditional Plans
paragraphs: All three multistate HDHPs generally covered the same services as those  covered by their traditional plan counterparts. These plans covered the  same broad categories of services, such as preventive, diagnostic,  maternity, surgical, outpatient, and emergency care, and all plans typically  covered the same services within these categories. While each HDHP  defined preventive services slightly differently, each plan covered certain  core services:  routine physical exam,  routine immunizations,    cholesterol screening,    colorectal cancer screening,    annual prostate-specific antigen test,    well-child care.
These same services were also covered by the traditional plans. The few  instances where covered services differed typically involved vision, dental,  or chiropractic care benefits. For example, one HDHP did not include  glasses or contact lenses in its vision care coverage, while its counterpart  plan did.
While the same services were typically covered by the three multistate  HDHPs and their traditional plan counterparts, the plans sometimes  imposed different restrictions and stipulations on the coverage of these  services. For example, one HDHP allowed more frequent vision exams,  but covered fewer days in skilled nursing facilities relative to the  traditional plan. Another HDHP had no time restrictions for receiving  emergency services following an accidental injury, while the traditional  plan did. In addition, the HDHP for which the traditional plan counterparts  were HMOs offered coverage for out-of-network providers for  nonemergency care, while the HMOs did not. The other two HDHPs had  similar restrictions as the traditional plans on obtaining coverage from  out-of-network providers.
section_title: Enrollees’ Financial Responsibilities Usually Differed between FEHBP HDHPs and Traditional Plans
paragraphs: The three multistate HDHPs often differed from their traditional plan  counterparts in terms of enrollees’ financial responsibilities. All three  HDHPs had higher deductibles, ranging from $1,100 to $2,500 for  individual coverage and from $2,200 to $5,000 for family coverage,  compared to $450 to $950 and $900 to $1,900 in their traditional PPO  counterparts, respectively. Cost sharing also differed between HDHPs  and the traditional plan counterparts. All HDHPs offered preventive care  cost sharing for in-network providers that was the same or lower than the  traditional plans. In addition, while all HDHPs covered preventive services  before the deductible, those services were not always covered before the  deductible by the traditional PPO plans. All HDHPs required that the  deductible be met before prescription drug coverage began, whereas two  of the traditional plans covered all prescription drugs before the  deductible was met, and the third covered only generic drugs before the  deductible was met. After the deductible was met, all HDHPs had  comparable or lower cost sharing than the traditional plans for  prescription drugs. Cost sharing for physician office visits for  nonpreventive care and for hospital stays was mixed across plans—higher  for the traditional plan counterparts in some instances, but the same or  lower in others. Finally, two of the HDHPs had higher out-of-pocket  spending limits for in-network providers of $4,000 and $5,000 for  individual coverage and $8,000 and $10,000 for family coverage, compared  to $1,500 and $4,450 and $3,000 and $5,400 for their traditional  counterparts, respectively.
HDHPs more often had lower monthly premiums than their traditional  plan counterparts. One HDHP had lower premiums than both of its  traditional plan counterparts, another plan had lower premiums than one  of its two counterparts, and the third HDHP had lower premiums than a  majority of its 22 traditional plan counterparts. On average, enrollees’  monthly premiums for the three HDHPs were $91 for individual coverage  and $208 for family coverage, compared to $99 and $243 for their  traditional plan counterparts, respectively. (See table 3.)
Another difference between the HDHPs and their traditional plan  counterparts was the monthly contribution HDHPs made to the enrollee’s  HSA—the premium pass through—which was not a feature of the  traditional plans. The average monthly pass through of the three multistate  HDHPs was $82 for individual coverage and $165 for family coverage,  representing 93 percent and 81 percent of the employee’s share of the  monthly premium on average, respectively. The annual sum of the monthly  contributions represented an average of 53 percent of the annual  deductible across the three plans.
section_title: FEHBP HDHPs Provided Online Access to Decision Support Tools, but Did Not Always Include Health Care Quality and Cost Information
paragraphs: Each HDHP provided online account management tools and access to  health education information on the plan’s Web site. However, the extent  to which they also included provider quality and health care cost data was  more limited and varied across the plans. Moreover, the quality and cost  information provided on the HDHP Web sites was available to both HDHP  enrollees as well as to traditional plan enrollees.
subsections: section_title: FEHBP HDHPs Provided Access to Online Account Management Tools and Health Education Information
paragraphs: Each of the three multistate FEHBP HDHP Web sites provided online  access to account management tools and health education information.  The plans allowed enrollees to view their progress toward meeting their  deductibles and track their HSA balances online. They also provided  online access to certain health education information, including  information on general preventive care, common medical procedures and  conditions, various treatment options for certain conditions, information  concerning prescription drug alternatives, and a disease management  program. Two plans also provided a health risk assessment tool, and one  offered access to a health advice line.
section_title: The Extent to Which FEHBP HDHPs Provided Online Access to Provider- Specific Quality and Cost Information Varied
paragraphs: The HDHPs provided varying degrees of provider quality data. Two of the  three plans provided data on their Web sites for several measures to assess  hospital quality, including outcomes data, procedure volumes, and patient  safety ratings, and the other plan provided links to Web sites that  contained this type of information. None of the plans provided similar  process or outcome measures to assess individual physician quality,  although one plan provided information on physicians’ medical board  certifications. Each of the plans provided certain general information  about the physicians in the plan networks, such as their hospital  affiliations, languages spoken, and gender.
Cost information provided by the three multistate plans was limited. One  of the plans provided average hospital cost estimates and two provided  average physician cost estimates for a limited number of services. For  example, one plan provided average cost estimates within certain  geographic regions based on its own claims data for certain physician  services, such as diagnostic tests and surgical procedures. It also provided  estimated total annual costs to treat certain conditions, such as diabetes  and heart disease. None of the plans provided the actual payment rates  that would be charged to enrollees that the plan had negotiated with  specific hospitals or physicians. Two of the three plans provided access  to average retail prescription drug prices and estimates of out-of-pocket  costs for drugs, and all three plans provided actual prices for drugs  purchased through the mail-order pharmacy services offered by the plans.  None of the plans provided the actual payment rate the plan had  negotiated with particular retail pharmacies. (See table 4.)
The quality and cost information provided on each plan’s Web site was  made available to the enrollees of both HDHP and traditional plans. In  some instances, information was tailored to the specific plan in which an  individual was enrolled. For example, one plan’s out-of-pocket cost  estimates for prescription drugs took into account plan-specific coverage  and cost-sharing features.
section_title: Concluding Observations
paragraphs: Like many large employers, the FEHBP has expanded enrollee health plan  choices by offering HDHPs combined with HSAs. While first-year  enrollment is modest, the number of carriers offering these products in  2005 and expected to offer them in 2006 indicates that OPM and health  insurance carriers anticipate continued interest in these new plans.
Although the first-year enrollment in FEHBP HDHPs may not predict  future trends, it does raise the possibility that individuals with certain  demographic characteristics may be disproportionately attracted to these  plans. For example, first-year HDHP enrollees had consistently higher  incomes across all age groups than enrollees of another new plan and all  FEHBP enrollees. This may suggest that aspects of HDHPs—such as the  greater financial exposure coupled with the potential for tax-advantaged  savings—uniquely attract higher-income individuals with the means to pay  higher deductibles and the desire to accrue tax-free savings. First-year  enrollees were also younger on average than all FEHBP enrollees;  however, they were not younger than enrollees in another new plan. Thus  it is not clear whether younger individuals were uniquely attracted to  HDHPs, or if younger enrollees are typical of recently introduced health  plans in general. Additional years of enrollment data will be necessary to  determine whether characteristics of first-year enrollees are predictive of  future trends; to identify other important characteristics of HDHP  enrollees, such as their health status; and to assess the implications of  these enrollment trends for the FEHBP.
HDHPs, like other CDHPs, are premised on the notion that enrollees will  become more actively involved in making health care purchase decisions  than enrollees of traditional health plans. To do so, enrollees need  information to help them assess the cost and quality trade-offs between  different health care treatments and providers. However, the extent to  which FEHBP HDHPs made such information available to enrollees was  varied and limited, and HDHP enrollees were not provided any more or  different information than was provided to traditional plan enrollees. Most  notably lacking was specific information to assess the quality of health  care provided by particular physicians and the actual prices plans had  negotiated with particular providers. Some of this information may  become available in the future. Two of the three largest HDHPs were  developing physician-specific patient satisfaction ratings to help enrollees  assess physician quality, and one had initiated a pilot project to provide  enrollees with the actual, negotiated prices they would pay for certain  services performed by a particular provider. Until such provider-specific  quality and cost data become more widely available, the CDHP goal of  having enrollees make health care purchase decisions based on an  informed assessment of the quality/cost trade-offs may not be fully  realized.
section_title: Agency Comments
paragraphs: We received comments on a draft of this report from OPM (see app. I).  OPM expressed interest in our findings on the differences in  characteristics of first-year HDHP enrollees compared to traditional  FEHBP plan enrollees, and said that it would monitor enrollment trends  over time to assess whether certain individuals—such as younger or  healthier individuals—disproportionately enroll in HDHPs. OPM also said  that it would continue to encourage plans to expand the decision support  information they provide to enrollees, including the pricing of health care  services.
As agreed with your offices, unless you publicly announce the contents of  this report earlier, we plan no further distribution of it until 30 days after  its issue date. At that time, we will send copies to the Director of OPM and  other interested parties. We will also make copies available to others upon  request. This report is also available at no charge on GAO’s Web site at  http://www.gao.gov.
If you or your staffs have any questions about this report, please contact  me at (202) 512-7119 or at dickenj@gao.gov. Contact points for our Offices  of Congressional Relations and Public Affairs may be found on the last  page of this report. Randy DiRosa, Assistant Director; Gerardine Brennan;  and Laura Brogan made major contributions to this report.
section_title: Appendix I: Comments from the Office of Personnel Management