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NCQA Pushes for Clarity in HIX Proposed Rules

Cheryl Clark, for HealthLeaders Media, October 3, 2011

Health insurance exchanges are a key piece of the health reform law because they are intended to offer coverage to an estimated 15.8 million enrollees in 2014, when they must begin, to 30.6 million by 2019, including many who are denied or can't afford coverage today.

"Our experience in working with states and their quality report cards is that they do choose different things to focus on," Thomas said. But if states allow plans to report on different measures, the consumer will not know how to judge one plan from another.

"It would be a shame if these systems don't end up delivering better quality of care."

CMS should also specify how health insurance carriers may describe their plans. "We strongly advise against letting plans simply submit essays describing their quality strategies, although we recognize that some qualitative review may be necessary in early stages of evaluation.

"In our experience we have found that essays can be misleading and subject to inconsistent rating by different evaluators." The plans should be required to "provide documentation that supports the statements and structure information to allow for comparisons."

Thomas said in an interview that two states that already have their exchange material are Utah and Massachusetts. "In Utah, we understand they have every intention to put quality ratings on their website but they haven't done it yet. And in Massachusetts, it's available but it's not prominent."

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