Evaluation of Parity in the Federal Employees Health Benefits (FEHB) Program: Final Report. Framework for Evaluating the Implementation of Parity in the FEHB Program

12/31/2004

The logic model for understanding the relationship between implementing benefit changes and new methods for managing care and their impact on access, utilization, cost, and quality appears in Figure II-1. The logic model provides a framework for the evaluation. It depicts a sequence of moves from implementing the policy of the President to have all FEHB Program plans offer MH/SA parity, through the required plan changes, to expected changes in access, utilization, and cost and their impact on quality. The logic model also provides a template that maps the research questions and data collection approaches. The result is a matrix of research domains, questions, and methods that is presented in Table II-1.

Figure II-1. Logic Model: Evaluating parity in the FEHB program

Figure II-1. Logic Model: Evaluating parity in the FEHB program

The logic model describes a rational approach to policy and programmatic changes with the following sequence of steps. It was anticipated that carriers and plans would alter their nominal benefits according to the instructions in the call letter from the OPM. In other words, they would eliminate special deductibles and copayments and other “demand side” limits on, for example, inpatient days or outpatient visits that previously applied to MH/SA benefits. Plans could be expected to respond to this change in nominal benefits by altering their management and payment practices in an effort to control costs on the “supply side,” such as through changes in utilization management practices and risk-sharing arrangements with providers. Such changes in effective benefits could be expected to have the following consequences:

  • changes in access and patterns of use,
  • selection of specific plans by individuals, and
  • changes in plan and beneficiary spending.

Changing patterns of access and utilization might also affect the quality of care provided.

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