Evaluation of Parity in the Federal Employees Health Benefits (FEHB) Program: Final Report. FEHB Network Providers’ Experience Implementing Parity

12/31/2004

Provider focus groups were conducted to assess providers’ awareness and perceptions of the parity benefit implementation. Each focus group was audiotaped and verbatim transcripts prepared from these tapes. The transcripts were then systematically analyzed for key themes.

Key Research Questions

PERT researchers developed a discussion guide for the focus groups, which was approved by the GPOs. The discussion guide included questions on these topics:

  • Awareness of the implementation of parity for FEHB beneficiary MH/SA service users;
  • Providers’ practice patterns;
  • Reimbursement arrangements;
  • Knowledge, perceptions, and attitudes about managed care in general;
  • Knowledge, perceptions, and attitudes about quality of care, particularly pre- versus post-parity comparisons; and
  • Effect of FEHB parity on providers’ practice and service user care.

Data Collection and Analytic Methods

To ascertain providers’ awareness and perceptions of the parity implementation and their managed care arrangements more broadly, we conducted six focus groups with a total of 43 in-network providers in three geographic regions (served by five of the nine plans) at 10 months, 15 months, and 32 months after the parity implementation.

The providers represented psychiatrists, psychologists, and licensed social workers working in a variety of inpatient and outpatient capacities across a range of public and private service settings. They provided assessment, therapeutic interventions, medication evaluation, and forensic services in settings such as community mental health centers, psychiatric and general hospitals, nursing homes, and partial hospitalization programs. This component of the evaluation contributed qualitative data on provider experiences of the parity implementation and provided additional context for interpreting other evaluation findings.

Focus group participants were drawn from a pool of clinicians providing a high volume of specialty MH/SA services to FEHB plan beneficiaries in the selected plans serving these three regions. The participants were selected from among psychologists, psychiatrists, social workers, certified counselors, and substance abuse counselors. The high-volume providers (i.e., providing services to the greatest number of FEHB plan beneficiaries in the prior year) comprised the sampling frame for drawing the focus group participants.23

Two PERT researchers, a psychiatrist and a clinical psychologist, both with mental health policy backgrounds, moderated the focus groups.

  • The Western State focus groups were conducted in November 2001, with 12 participants.
  • The Mid-Atlantic State focus groups occurred in March 2003, with 27 participants.
  • The Northeast State focus groups were conducted in September 2003, with four participants.24

Findings

Providers’ Awareness of the Parity Benefit Implementation

The FEHB plan MH/SA providers who participated in the focus groups had a limited awareness and very limited understanding of the FEHB parity benefit for Federal employees. None of the providers clearly understood how the parity benefit might affect their provision of MH/SA services to FEHB beneficiaries. Nearly all the providers in the Western and Mid-Atlantic States’ groups confused the FEHB parity policy with their respective State’s parity law.

Most providers vaguely remembered getting a letter from one or more health plans telling them about implementing parity in the FEHB Program. A few thought they might have first heard about parity in the FEHB by reading about it in a professional journal or newsletter.

Only three providers were clearly aware that a parity policy had been implemented for FEHB MH/SA service users. None of the three, however, clearly understood what this information meant. As a result, some of the evaluation questions could not be answered by any of the providers.

Providers’ Understanding of the Parity Benefit Implementation

The providers’ common confusion about what exactly was meant by “parity in the FEHB Program” was exemplified by one participant’s request to the focus group leaders, about 20 minutes into the session, “Can you tell us a little bit more about parity? What does it mean?” The other providers in the group quickly echoed their desire to know the same.

All the providers demonstrated a general understanding of the conceptual meaning of “parity for MH/SA benefits,” i.e., health insurance providing the same level of benefits for mental disorders as for general medical disorders. In the Western and Mid-Atlantic States’ groups, however, nearly all providers expressed confusion in attempting to distinguish between their State’s MH/SA parity law and parity in the FEHB plans.

Among the three providers who were clearly aware of the FEHB parity policy implementation, one perceived no practical difference in benefits for Federal employees versus non-Federal employees since the January 2001 parity implementation. This comment suggests that, while the provider was aware that a parity policy had been implemented for FEHB beneficiaries, he was largely unaware of the substance of this benefits change. Another provider commented that the FEHB parity policy meant that Federal MH/SA service users had an expanded choice of providers. In fact, this was not a feature of the parity benefit, as it applies only to in-network providers.

Providers’ Awareness of their FEHB Patients

While six of the 12 providers in the Western State focus group could clearly distinguish their service users who were Federal employees from their other service users, i.e., they could think of individual MH/SA service users whom they knew were Federal employees, few of the providers in the Mid-Atlantic or Northeast States’ focus groups could do so.

Providers whose practice included claims or billing staff indicated that they were the people who would know whether a service user was in the FEHB Program. Although the PERT attempted to include providers’ claims and billing staff in the focus groups, none of the providers followed up on the request to invite these staff.

Providers generally knew the occupations of their service users but did not necessarily know if those occupations qualified them as Federal employees or if they were covered by the FEHB Program.

Service Users’ Awareness of the Parity Implementation

None of the providers could recollect a service user who had expressed an awareness of the FEHB parity benefit.

Providers’ Experience of the Parity Implementation

Among the three providers who were aware of the implementation of parity in the FEHB Program, none could readily disentangle the effect of the FEHB parity benefit from that of managed care in general. These three providers thought that introducing parity for Federal service users meant introducing managed care, which nearly all focus group participants perceived negatively.

For these three providers, equating parity in the FEHB plans with managed care meant that the net effect of the parity policy was that FEHB MH/SA service users were neither better nor worse off than those outside the FEHB plans.

The consensus across all providers was that FEHB beneficiaries had fairly good benefits before implementing parity and they continued to have good benefits after implementing parity, even though none of the providers liked managed care.

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