This annual report on the activities of the Ombudsman for the Office of State and Local Health Benefits Programs (OHB) covers the period from July 1, 2024 through June 30, 2025. During this fiscal year, the Ombudsman’s team helped to resolve issues encountered by employees, retirees and their covered dependents involving access and eligibility for health care under the Commonwealth’s Health Benefits Program. As part of its responsibilities, the team assisted covered members in understanding their benefits, as well as their rights, and the processes available through the program. The team also guided covered members in the utilization of available health plan resources.

In fiscal year 2025, the Ombudsman’s team handled 9,123 requests for assistance or complaints (cases) and reviewed 255 formal appeal requests. In an effort to maximize the accessibility and effectiveness of the Health Benefits Program, the team continues to:

• resolve issues and solve problems in a timely manner,
• analyze issues, identify emerging trends and work to correct systemic issues, and
• update policies and provide meaningful communication to our customers.

Key initiatives and projects managed during the fiscal year include:

CRM Migration Project - The Office of Health Benefits was using an on-premises Dynamics CRM (Customer Relationship Management) system to track and record incoming inquiries and requests from our customers. The on-premises system was functional, but it did not offer the flexibility and accessibility needed for the efficient handling of the requests submitted to the OHB team.

The DHRM Information Technology (IT) team proposed a plan to migrate the existing Dynamics CRM system (on-premises) to the cloud solution, Dynamics 365, to capitalize on enhanced security, reliability and the numerous other benefits of cloud computing. The cloud version of CRM reduces the maintenance and system updates typically associated with on-premises upkeep, which will allow OHB to devote more time and resources into fulfilling their core business functions.

The Ombudsman and Associate Director for OHB Systems worked with the DHRM IT Project Owners and an outside vendor to develop the specification for the OHB version of CRM and coordinated the activities for migrating the existing CRM information to the cloud version. All tasks were performed to ensure the project met the Department’s expectations and the security standards of the Commonwealth of Virginia were upheld.

OHB migrated to the Dynamics 365 version of CRM in April 2025 with minimum issues noted. We credit the intense attention to details of the existing systems specifications and communication between the parties involved in the development process with the relatively smooth transition to the new environment.

The teams, both OHB and IT, continue to review and make recommendations to enhance the new system to ensure we maximize the available functionality.

State Employee Health & Wellness Benefits Guide - The Ombudsman, OHB Policy and the CommonHealth teams collaborated on the development of a resource to provide employees with a single document with the information on the health and wellness benefits available under the Program. The new Employee Health & Wellness Benefits Guide was released in August 2024. The guide outlined the benefits available based on the employee’s health plan as well as benefits available to all employees whether they are enrolled in coverage. Many of the benefits are provided at no additional cost to members. This new informational resource will hopefully help employees as they progress towards their health and wellness goals.

Communication Campaigns - The Ombudsman and members of the OHB team worked on several communication campaigns during this fiscal year to increase employee awareness of additional programs included with their health plan benefits. Two of the main campaigns were for:

• Virtual Physical Therapy - The virtual in-home physical therapy benefit was introduced in July for state and TLC members enrolled in one of the health plans administered by Anthem. To increase awareness of the new digital physical therapy benefit, a multi-touch email and mail campaign initiated in October 2024. Several direct mailers and emails were sent to members 18 and older promoting the LiveHealth Online Thrive: Healthy Back & Joints program. Female members also received information on Bloom, the pelvic health physical therapy program. Members had the option to opt out of the emails if they wanted to stop receiving communications.

• Catapult - The Office of Health Benefits (OHB) manages the State Health Benefits Program with a goal of ensuring that our members are utilizing the preventive benefits that are available to them. As part of the engagement plan, OHB worked with the vendors to develop an employee email to promote engagement in the Catapult program. Catapult Health’s Virtual Checkup® Home Kit provides members with convenient, simple, and comprehensive health checkups. The virtual checkup is provided as part of the COVA Care, COVA HealthAware and COVA HDHP plan benefits. The email campaign was directed to members who had not received an annual preventative exam.