Feds release framework to assess exchange plans


The U.S. Department of Health & Human Services released a draft methods-and-methodology framework to rate exchange-offered health plans based on quality and outcomes, customer experience and cost. When finalized, these measures will determine if health plans meet Affordable Health Care Act requirements. HHS is now accepting public comments on its draft.  

HHS loosely based the quality rating system on the Medicare Advantage five-star rating system. Together with customer satisfaction surveys, the new measures will "provide sound, reliable and meaningful QHP [quality health plan] information," according to the HHS notice.

Insurers can use that information to improve quality, customers can use it to comparison shop for insurance products, and  regulators to certify and oversee health plans.

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The overarching aim is to "encourage the delivery of higher quality healthcare services, expand access to care, and improve health outcomes for QHP enrollees," HHS states in the notice.       

The rating system includes two components--performance information and rating methodology--and 10 associated elements. HHS outlined data insurers may need to collect and report about exchange products, as well as included methods for collecting data and selecting samples.  

HHS plans to release new regulations about how insurers should collect and submit quality-related information. The agency also will produce technical guidance about the rating system's measure specifications along with rating methodology guidelines.

The quality rating system framework follows a maelstrom of complaints about insurance plan cancelations across the country due to failure to meet Affordable Care Act requirements, as FierceHealthPayer previously reported.  This prompted President Obama to apologize to affected Americans, with the White House subsequently providing a one-year extension for canceled plans.

For more:
- read the HHS notice (.pdf)

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