Evaluating quality in health care exchanges

Lately, the topic of implementing the new health insurance exchanges is at the forefront of nearly every health policy conversation; politicians, legislators, health care experts and reporters are all buzzing about how and when the herculean provision of the health care law will be executed.

As it stands now, the exchanges will be open for enrollment on October 1, 2013. To facilitate this process, the Centers for Medicare and Medicaid Services (CMS) recently released a new (significantly shortened) application form, which the agency touts as simplified and consumer-friendly. According to CMS, one can apply for insurance coverage by paper form, phone or online — the last even promising to be a “dynamic experience” that shortens the application process based on individuals’ responses.

However, as health care organizations, state governments and the administration struggle to make deadlines and hit benchmarks, it is important to ensure that the plans sold on the exchanges are  held accountable to quality standards. Last year CMS decided to delay implementation of quality reporting requirements until 2016, with the expectation that state-based exchanges would follow suit.

In response to this move, ACHP sent a letter to Marilyn Tavenner, acting administrator of CMS, recommending that the agency instate quality reporting  in 2014. Initially, these metrics would be based off of quality measures — such as HEDIS and CAHPS — that have been tested and used on the commercial market for many years. The accelerated timetable is essential to ensuring many of the basic underpinnings of the health care law, such as improving health outcomes, preventing hospital readmissions, improving patient safety and reducing health disparities, remain a priority.

ACHP’s comment letter, which is bolstered by examples of quality improvement strategies from ACHP member plans, highlights the necessity of focusing on quality, and emphasizes how doing so will help achieve better population health, improved health outcomes and lower costs. As implementation of the exchanges speeds forward, this is something everyone — lawmakers, providers, insurers and the media alike — should keep in mind.


Wendi Bootes