Evaluation of Parity in the Federal Employees Health Benefits (FEHB) Program: Final Report. Research Questions

12/31/2004

The study’s key research questions are described in Table II-1 and reflect the logic model in Figure II-1. Table II-1 identifies the data sources and collection methods most relevant to each research question. chapter III, Implementation of Parity, and chapter IV, Impact of Parity, provide further details on more specific research questions, data sources, data collection methods, and analytic strategies.

Table II-1. Data sources, collection methods, and analysis methods for key research questions

  Research questions Data source Data collection method Data analysis method
Benefits How has the design of MH/SA benefits offered by FEHB plans changed as a result of the parity policy? OPM website/plan documents for all FEHB plans

OPM/Plan personnel

Document review

Key informant interviews (site visits to 8 selected plans) and FEHB Parity Reporting Requirement (for all plans)

  • Content analysis
  • Descriptive and simple inferential statistics
  • Case study analysis
How have the policies and procedures related to the management of the MH/SA benefits offered by the FEHB plan changed as a result of the parity policy? OPM/Plan personnel Key informant interviews (site visits) and FEHB Parity Reporting Requirement
  • Descriptive and simple inferential statistics
  • Case study analysis
How have the structure and management of general medical health benefits offered by FEHB plans changed as a result of the parity policy? OPM/Plan personnel Key informant interviews (site visits) and FEHB Parity Reporting Requirement (for all plans)
  • Descriptive and simple inferential statistics
  • Case study analysis
Cost Have aggregate and per-enrollee costs for MH/SA services within select FEHB plans changed after implementation of parity?

How do these changes compare to secular trends?

Plan and comparison group claims data Claims data files transferred to contractor from plans
  • Generalized linear models
  • Differences in differences models
Have out-of-pocket costs to beneficiaries utilizing MH/SA services (e.g., deductibles, copayments, and out-of-pocket limits) within select FEHB plans changed after implementation of parity?

How do these changes compare to secular trends?

Plan and comparison group claims data Claims data files transferred to contractor from plans
  • Multivariate models
  • Differences in differences models
Have FEHB plans incurred additional administrative costs attributable to the parity policy? Plan personnel Key informant interviews (site visits) to 8 selected plans
  • Case study analysis
Has the Federal Government incurred additional expenses (e.g., premium costs) attributable to the parity policy? OPM documents

OPM personnel

Document review

Key informant interviews (site visits) and FEHB Parity Reporting Requirement (for all plans)

  • Content analysis
  • Descriptive and simple inferential statistics
  • Case study analysis
Within select FEHB plans, is there evidence of either adverse or favorable risk selection among new enrollees or those disenrolling after the implementation of parity? OPM Health Benefits (Enrollment) Data File Claims data files transferred to contractor from plans
  • Generalized linear models
Access What are the patterns of access to MH/SA services within select FEHB plans both before and after the implementation of parity?

How do any changes compare to secular trends?

Plan and comparison group claims data Claims data files transferred to contractor from plans
  • Descriptive and simple inferential statistics
  • Differences in differences models
Do these patterns of access differ by type of user, type of service, level of service, or type of condition?

How do these patterns compare to secular trends?

Plan and comparison group claims data Claims data files transferred to contractor from plans
  • 2-part models
  • Differences in differences models
Utilization What are the patterns of service utilization for MH/SA services within select FEHB plans both before and after the implementation of parity?

How do these changes compare to secular trends?

Plan and comparison group claims data Claims data files transferred to contractor from plans
  • Descriptive and simple inferential statistics
  • Differences in differences models
Do these patterns of service utilization differ by type of user, type of service, level of service, or type of condition?

How do these patterns compare to secular trends?

Plan and comparison group claims data Claims data files transferred to contractor from plans
  • 2-part models
  • Differences in differences models
Quality What type of quality assurance strategies have FEHB plans implemented as a result of the parity policy (e.g., utilization review, case management, disease management protocols, patient care teams, or outcomes monitoring)? Plan personnel Key informant interviews (site visits to 8 selected plans) and FEHB Parity Reporting Requirement (for all plans)
  • Descriptive and simple inferential statistics
  • Case study analysis
Do FEHB plans utilize any evidence-based practice guidelines for the treatment of mental health, substance abuse, or any other conditions? Plan personnel Key informant interviews (site visits to 8 selected plans)
  • Case study analysis
If yes, how well do the patterns of care for MH/SA or other conditions (as evidenced in administrative claims/encounter data) reflect adherence to proposed guidelines? Plan and comparison group claims data Claims data files transferred to contractor from plans
  • Quantitative analysis of treatment episodes
  • Differences in differences models
  • Descriptive and simple inferential statistics
Are there any changes in either the use of guidelines or adherence to guidelines that are related to the implementation of parity? Plan personnel Plan and comparison group claims data Key informant interviews (site visits to 8 selected plans) Claims data files transferred to contractor from plans
  • Case study analysis
  • Quantitative analysis of treatment episodes
  • Differences in differences models
  • Descriptive and simple inferential statistics

 

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