Exchanges Required to Provide Quality Metrics of Plans in 2016

FierceHealthPayer

August 1, 2014

Insurers selling plans on the marketplaces must disclose the metrics they use to determine the value and cost-effectiveness of plans beginning in 2016, as a way to improve the overall quality of healthcare.

The Affordable Care Act grants exchanges the right to allow consumers to compare plans based on quality and value, set common quality improvement requirements and collect quality and cost data to inform improvements. Of the 36 state-based exchanges, 13 have already taken steps to promote quality in the plans sold through their online marketplaces, according to an issue brief from the Commonwealth Fund.

During this past enrollment period, four of the 13 state exchanges chose to contract with insurers selling health plans based on certain levels of quality and value, nine states publicly displayed or linked to quality information and 11 collected quality information from insurers.

Massachusetts and California are two of the most prominent exchanges that selectively contracted with insurers, FierceHealthPayer previously reported. Massachusetts, for example, required insurers to develop plans to use more risk-based payment models. And California only allowed insurers to sell plans on its exchange if they were affordable, provided access to high-quality care and reduced health disparities.

However, the Commonwealth Fund questioned whether these metrics will actually steer consumers to choose plans based on quality and value data. The problem, the authors said, is that providing quality information has limitations, especially in the early years of exchanges.

"Many consumers are navigating the complexities of selecting a private insurance plan for the first time this year, and are likely to be more focused on factors like premiums and cost-sharing," the issue brief says.

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