In 2003, the APWU plan became the first CDHP offered to federal  employees. A savings account to pay for services under the deductible. The FEHBP has recently begun to offer CDHPs to federal employees. The APWU CDHP

Administered by Definity Health Plan, the APWU CDHP is a high- deductible PPO plan coupled with an HRA. APWU CDHP Enrollees Included Few Retirees and Elderly and Were Younger than Other FEHBP Enrollees

Fewer retirees and elderly people selected the APWU CDHP compared to  the national PPO plans, a phenomenon also found among the other new  plans. The average age of APWU CDHP enrollees was comparable to that of  enrollees in other new plans, but lower than enrollees in the national PPO  plans by about 15 years—47 each in both the APWU CDHP and the other  new plans compared to 62 for the PPO plans. Excluding the elderly and  retirees, the average ages of enrollees in the APWU CDHP, the other new  plans, and the national PPO plans were more similar—45, 43, and 47,  respectively. APWU CDHP Enrollees Were Healthier, Better Educated, and More Likely to Enroll in Individual Plans

Excluding enrollees over age 65, the proportion of APWU CDHP enrollees  who reported on annual satisfaction surveys being in “excellent” or “very  good” health status was higher than among the other new plan and PPO  plan enrollees. The  proportion of APWU CDHP enrollees under the age of 65 who reported  having a 4-year or higher college degree was higher than among the other  new plan and the PPO plan enrollees. APWU CDHP Enrollee Satisfaction with Overall Plan Performance Was Mixed Compared to Other Plans

On the overall plan performance measure included in annual consumer  satisfaction surveys, APWU CDHP enrollees were more satisfied than  other new plan enrollees, but less satisfied than national PPO plan  enrollees—67 percent versus 53 and 76 percent, respectively. APWU CDHP Enrollees Were Generally as Satisfied as Other Plan Enrollees on Four of Five Specific Performance Measures

For four of five specific plan performance measures—access to health  care, timeliness of health care, provider communications, and claims  processing—APWU CDHP enrollee satisfaction was generally comparable  to that of other enrollees. Moreover, for three of the components that constitute the customer  service performance measure, APWU CDHP enrollees were less satisfied  than national PPO plan enrollees. The components are satisfaction with  finding or understanding information, satisfaction with getting help when  calling customer service, and satisfaction with the health plan paperwork. APWU CDHP Enrollee Access to Provider Networks and Discounts Was Generally Comparable to Other FEHBP Plans

Provider networks appeared to provide APWU CDHP enrollees with  similar access to health care providers compared to networks of other  FEHBP plans. In the remaining 9 states, accounting for approximately 16 percent of total  plan enrollment, the APWU CDHP used networks that were either  nationally accredited, or were comparable in size to networks used by  other FEHBP plans based on counts of hospitals or physicians included in  the network. Across all states, the average hospital inpatient  and physician discounts for the APWU CDHP and another national PPO  plan differed by no more than 2 percentage points. Agency Comments and Comments from APWU

We received comments on a draft of this report from OPM (see app. I) and  APWU. Both generally concurred with our findings. Regarding the potential for CDHPs to  disproportionately attract healthier enrollees, OPM said that while  enrollment in the APWU CDHP is growing, the plan accounted for a small  fraction of total FEHBP enrollment and that OPM did not anticipate any  harm accruing to other FEHBP enrollees as a result of its enrollment  trends. Nevertheless, OPM said it would continue to monitor enrollment  trends and take appropriate action to eliminate or minimize any adverse  effects. Appendix I: Comments from the Office of Personnel Management
Why GAO Did This Study

Since 2003, the Federal Employees Health Benefits Program (FEHBP) has offered "consumer-directed" health plans (CDHP) to federal employees. A CDHP is a high-deductible health plan coupled with a savings account enrollees use to pay for health care. Unused balances may accumulate for future use, providing enrollees the incentive to purchase health care prudently. However, some have expressed concern that CDHPs may attract younger and healthier enrollees, leaving older, less healthy enrollees to drive up costs in traditional plans. They also question whether enrollees are satisfied with the plans, and have sufficient access to health care providers and discounts on health care services. GAO was asked to study the first FEHBP CDHP, offered by the American Postal Workers Union (APWU). GAO compared the number, characteristics, and satisfaction of APWU enrollees to those of FEHBP enrollees in other recently introduced (new) non-CDHP plans, and national preferred provider organization (PPO) plans. GAO also compared the APWU CDHP provider networks and discounts to those of other FEHBP plans.

What GAO Found

The APWU CDHP is a small but growing FEHBP health plan whose enrollees were younger than PPO plan enrollees, and healthier and better educated than other new plan and PPO enrollees. The average age of APWU CDHP and other new plan enrollees was the same (47 years), but younger than that of PPO plan enrollees (62 years), largely because fewer retirees and elderly people selected the new plans. Excluding retirees and the elderly, the average age of enrollees was more similar across the plans. A larger share of nonelderly enrollees in the APWU CDHP reported being in "excellent" or "very good" health status compared to the other new plan and PPO plan enrollees--73 percent versus 64 and 58 percent, respectively. Similarly, a larger share of nonelderly enrollees in the APWU CDHP reported having a 4-year or higher college degree compared to enrollees in the other new plans and PPO plans--49 percent versus 42 and 36 percent, respectively. Enrollee satisfaction with the APWU CDHP was mixed compared to enrollee satisfaction with the other FEHBP plans. For overall plan performance, APWU enrollees were more satisfied than other new plan enrollees, but less satisfied than PPO plan enrollees. For four of five specific quality measures--access to health care, timeliness of health care, provider communication, and claims processing--APWU enrollees were as satisfied as other enrollees. On the fifth measure, customer service, APWU enrollees were more satisfied than other new plan enrollees, but less satisfied than PPO plan enrollees. In particular, a lower share of APWU enrollees were satisfied with their ability to find or understand written or online plan information, the help provided by customer service, and the amount of paperwork required by the plan. The APWU CDHP provider networks and discounts were comparable to other FEHBP PPO plans. In 21 states, the APWU CDHP used the same networks used by other national PPO plans. In the remaining states, the APWU CDHP networks were among the most commonly used networks nationwide, or were large, nationally accredited, or comparable in size to networks used by other FEHBP plans. Across all states the average hospital inpatient and physician discounts obtained by the APWU CDHP were within 2 percentage points of the discounts obtained by another large national FEHBP PPO plan. GAO received comments on a draft of this report from the Office of Personnel Management (OPM) and APWU. Both generally concurred with our findings. Regarding the potential for CDHPs to disproportionately attract healthier enrollees, OPM said it would continue to monitor the enrollment trends and take appropriate action to eliminate or minimize any adverse effects.