Posted: March 1, 2013
Several states are scrambling to decide what information about quality would be useful to the millions of people and small businesses expected to shop for insurance coverage in new marketplaces beginning in October.
This fall, health insurers in a few states will be seeing stars.
Not the celestial kind, but stars that reflect their scores on quality measures picked to help consumers make informed decisions when buying health coverage.
In Oregon, insurers will get one to four stars depending on their screening rates for breast cancer and complaint resolution, among other measures. Maryland is considering ranking insurers on how they deal with chronic illnesses and interact with minority groups. Colorado will rate them based on a federal consumer satisfaction survey.
Those states and a handful of others, among them Minnesota and California, are opting to do the ratings early, before the federal health law requires them in 2016. They're scrambling to decide what to measure and how to translate that into something useful to the millions of people and small businesses expected to shop for coverage in the new marketplaces beginning in October.
The plans sold in those markets will take effect in January, when most Americans must carry health insurance. The idea is to give consumers information to compare the policies on more than price tags or lists of benefits.
"If you've got a history of breast cancer in your family, you may want to know how well that insurance company did to make sure women between 40 and 69 got a mammogram," said Laura Etherton, health care policy analyst for US PIRG, an advocacy group.
Proponents say quality ratings were included in the health law not only to help consumers, but to improve the health system. They contend that measuring how well insurers, hospitals or physicians follow appropriate treatment guidelines, screen for cancer, save heart attack victims or treat diabetes is the first step toward improving care.
Still, skeptics say that progress remains debatable after more than two decades of public reporting of quality measures by private firms and government agencies.
Another problem is that people shopping for insurance say they want quality information, but most people tend to focus on cost and whether their doctor is in an insurers' network, said Betsy Imholz, director of special projects for Consumers Union. "Many quality rankings show everyone is in the middle, or everyone is above average ... so people don't pay much attention to it," she said.
For the states moving to meet the law's requirement for quality comparisons ahead of the 2016 deadline, a big challenge is deciding what to measure. Hundreds of benchmarks exist and they must be adjusted to account for differences among plans' enrollees.
Oregon officials considered more than 2,000 quality measures, paring them down to 13 with the help of a consulting firm.
In Maryland, officials expect to rate insurers on a five-star scale based on dozens of quality measures tracked by state regulators, including how effectively insurers use wellness and disease prevention efforts. The state also plans to make a detailed report for each plan available for consumers who want to know more, said Tequila Terry, the state marketplace's director of plan and partner management.
Consumer advocates say they will seek adoption of more useful measures in the future such as how often patients have to seek costly out-of-network care because they cannot find a specialist or treatment in a plan's network.
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