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Monday, February 3, 2014

Proposed New Quality Rating Systems Will Allow Consumers to Rate Health Plans in the Health Insurance Marketplaces

Kathleen Stoll

Director of Health Policy

Consumers will soon have a powerful new tool that allows them to use data to measure the quality of different health plans offered in their state’s health insurance marketplace. This tool is based on the new Quality Rating System (QRS) proposed by the Centers for Medicare and Medicaid Services (CMS). It is a notable step forward in the adoption of employing consumer-friendly data transparency practices to help individuals make data-driven, informed decisions about their health care choices. In November 2013, The Quality Rating System will require insurance plans to submit data on health care quality, health outcomes, consumer satisfaction (based on an enrollee survey), and the cost of care. CMS’ proposal requires plans to report data on 42 indicators for family or individual plans and 25 indicators for child-only plans.

Sharing this data in a consumer-friendly manner is critical to the success of the new Quality Rating System, both for consumers shopping for plans and for state marketplace administrators contracting with plans to participate in state marketplaces.

Features of a consumer-friendly Quality Rating System for health insurance plans in the marketplace:

  • displays transparent, accurate, current data on the quality and value of each plan to allow consumers to compare and contrast plan performance uniformly and easily across all plans
  • creates a much-needed new data source on plan performance that allows state marketplace administrators to feature strong-performing plans and weed out poorly performing ones
  • helps state marketplace administrators create incentives (through contract requirements or bonuses) for health plans to improve their plan’s Quality Rating System scores. To receive these incentives, health plans can introduce specific reforms that improve the quality of a health plan based on how it charges for services or how well it delivers health care to consumers.
  • strengthens the ability of states to make accurate, data-driven decisions when reviewing and approving health insurance plan premium rate increase requests. States can access data on whether a plan is doing basic care coordination or employing other system improvement payment and delivery reforms to hold down costs.
  • provides decision-makers with data that allow them to measure the effectiveness and quality of the health care that diverse populations are receiving, and to ensure that health care providers and plans address any disparities in how that care is being delivered.

We will keep you posted in future blogs as the Quality Rating System for plans in the new health insurance marketplaces moves forward. As we all continue our work helping consumers select the best plan for their needs; as well as encouraging state marketplaces to take a more proactive role in selecting high-value plans, controlling premiums, and driving system change; the Quality Rating System will be a powerful new tool for consumer advocates.

Families USA’s comments to the Centers for Medicare and Medicaid Services on the proposed Quality Rating System

Families USA’s comments on the new QRS system are supportive overall, though we identified areas where the measures of quality should be expanded and improved. For example, while we found that the proposed individual indicators did a good job of measuring provider performance, we recommended that additional measures of plan performance be added. Among our recommendations was inclusion of indicators that measure:
  • wait time to talk to a health plan customer service representative
  • accuracy and clarity of information delivered by customer service representatives
  • how often claims were denied, how clearly the plan communicated the reason for the denial, and the timeliness and ease of the process for a consumer to appeal a denied claim.