State Health Insurance Exchange Websites:

Transcription

1 State Health Insurance Exchange Websites: A Review, Discussion and Recommendations Presented to the NCQA National Policy Conference December 13, 2011 Carol Cronin-Executive Director Informed Patient Institute 1

2 Informed Patient Institute Mission To improve the quality of health care by helping the public make more informed choices about their care Objectives To educate the public about health care quality, patient safety and patient rights and responsibilities To facilitate access to credible information about health care organizations and professionals To advocate for more, and more useful, health care quality information IPI is a non-profit organization based in Annapolis MD 2

3 ACA Report Card Requirements Maintain Internet site for consumers about their choices Site will contain: Standardized plan comparative information Plan ratings Enrollee satisfaction DHHS to develop model template Information must be in plain language 3

4 Methodology of Report Card Review Project conducted for AARP Analyzed 70 managed care report cards Oct. - Nov Drawn from IPI database Geography: 7 national report cards 62 state report cards 1 regional 4

5 Types of Report Cards State Insurance Departments (25) State Health Departments (15) Medicaid (7) Non-profit Community Collaboratives (5) National Report Cards (5) Public Employers (5 2 national) Employer Coalitions (4) Health Insurance Exchanges (4) CT (Small Business), MA, UT, WI (prototype) 5

6 Number of Plan Choices on the Exchange Too many choices: Overwhelm decision making Too few: Limit optimal match to needs/less competition Plan choices reflect geographic differences in health care More managed care plans in MD than WY Different aspects of choice: Company that offers the plan (CIGNA, BC/BS) Type of health plan (HMO vs. PPO vs. POS) Actual plan benefits (Deductibles, what is covered etc.) 6

7 Number of Plan Choices (Cont.) Range of choices available in study: through Healthcare.gov (MD/WY) Medicare Health Plan Finder (WY/MD) MA Health Connector (Pittsfield/Boston) FEHBP (WY/MD) 6 - CalPERS RECOMMENDATIONS: Consider the burden of decision making fewer, rather than more, choices will assist in decision making Include tools and resources to help narrow choice Minimize confusion by considering ways to 7 standardize and name health plan benefit options

8 Quality and Patient Experience HEDIS Set of health plan performance measures Maintained by NCQA Over 50% of sites reviewed had HEDIS information CAHPS Survey assessing consumer experience Maintained by AHRQ Over 50% of sites reviewed had CAHPS information RECOMMENDATIONS: Include HEDIS and CAHPS information on Exchanges Feature quality information as prominently as plan costs Measure performance at level closest to that reflecting the plan that consumers enroll in that is feasible 8

9 Presentation Formats/Conveying Results How organize presentation of measures: By Disease/Condition or Broad Categories: Staying Healthy, Living with Illness Composites (rolling up measures into a single score) How convey results to indicate relative performance Stars, Words, Rank Ordering, Sorting RECOMMENDATIONS: Ensure performance can be interpreted at a glance /option to dig deeper Use an organizing framework to categorize information Include users in design and test 9

10 Benchmarks National or state average often used Stretch benchmarks - top 10% Best performing RECOMMENDATION: Consider using stretch benchmarks when creating plan scores to both motivate improvement and show variation among plans 10

11 Complaints/Grievances/Appeals Several types of measures found: Inside the plan (complaints/grievances to plan personnel, utilization review) Complaints made to external body such as State Insurance Dept. External appeal decisions complaints/grievances reviewed by independent external body Most of this information presented in charts with nos., percentages and ratios/not easy to interpret RECOMMENDATIONS: Integrate this type of information into Exchange sites Ability to interpret at-a-glance /Consider development of composite that rolls several measures into one score 11

12 Education and Decision Support Types of decision support: How to Choose, How to Use Worksheets/Glossaries Links to other useful information Videos Language Availability RECOMMENDATIONS: Assume no audience knowledge of health insurance/low health literacy/utilize federal resources on usability/literacy Ensure that information is culturally appropriate Include new media options, but have process for people without Internet 12

13 Future Issues that will Impact Reporting Health Plan Selection Tools Tools take users through a series of steps to help narrow plan choices/make decisions A variety are available: Pacific Business Group on Health/CalPERS Medicare Consumers' Checkbook FEHBP Plan SmartChoice RECOMMENDATIONS: Explore multiple decision support strategies to match tool with users' learning style (short-cuts vs. going through whole process) Test all decision aid tools 13

14 Integration of Provider Performance Information Use opportunity of choosing plan to consider what's inside the plan doctors/hospitals Growing number of provider report cards available nationally and in states CalHospital Compare (CA) MN Community Measurement Report card reviews: RECOMMENDATIONS: Capitalize on teachable moment of plan enrollment to think about quality of health providers inside plan Ensure the accuracy of information provided about doctors/hospitals 14

15 More Information Full Report: State Health Insurance Exchange Websites: A Review, Discussion and Recommendations for Providing Consumers Information about Quality and Performance By: Carol Cronin - Executive Director Informed Patient Institute c.cronin@comcast.net