Successful marketplaces set common standards for health plans, analysts say

Most state-run health insurance marketplaces are still stuck focusing on technical challenges, but those that want to get out front should be focusing on raising quality of care, according to a new Commonwealth Fund blog.

In a recent Commonwealth Fund issue, authors of the blog say they assessed efforts among the state-based health insurance marketplaces to implement the Affordable Care Act's (ACA's) quality improvement initiatives.

Although federal officials allowed the marketplaces to delay implementing key quality provisions of the law, the authors say they found that 13 of the 17 states operating their own marketplace moved forward with at least one of the quality-related provisions of the ACA, such as collecting quality data or making quality information public.

However, the authors also learned that using health insurance marketplaces as a vehicle for achieving better, more affordable care is easier said than done, the blog says.

To be successful, marketplaces need to set common standards and expectations across health plans, and overcome other barriers such as the lack of effective IT systems, the complexity of selecting effective quality measures and evidence-based delivery system reforms, the need for sufficient enrollment to make quality measurement statistically meaningful, and other complexities.

In the first year of implementation, these challenges were compounded by the marketplaces' technological and other operational difficulties.
As the federally facilitated and state-based marketplaces look to more widespread implementation of the ACA's quality improvement goals, they would do well to keep the following in mind:

  • Consumers need more support to make quality-driven plan choices
  • Greater standardization across the marketplaces and other purchasers can improve efficiency and drive greater adoption
  • We're a long way from plan competition based on quality performance

"The marketplaces can be a mechanism for promoting quality improvement and delivery system reform, and a few of the state-based marketplaces, such as in California and Massachusetts, are working toward that vision," the bloggers write. "But we still have a long way to go."

Health data analytics will play a key role in helping to improve quality of care, FierceHealthIT previously reported.

For more:
-here's the Commonwealth Fund blog