How health insurance exchanges can improve quality

Most of the attention given to the nascent state health insurance exchanges has largely focused on their role in improving access to insurance for individuals and small employers, not on the role they can play in improving health care quality.

As envisioned by the Affordable Care Act, health insurance exchanges provide an opportunity to create more organized and competitive insurance markets by offering a choice of plans, establishing rules on the offering and pricing of health plans, and giving consumers necessary information to make more informed choices about their care.

But the Affordable Care Act also makes exchanges an important vehicle for improving the quality of health care.

States have a number of options for using their exchange to help drive transparency, quality improvement, and delivery system reform, including:

  • Providing information about plan performance on quality metrics to consumers, so that they can more easily assess which plans do a better job providing the services important to them;
  • Aligning the exchange’s quality improvement and reimbursement strategies with other purchasers, from Medicaid and the state employees’ health plan to commercial insurers and employer purchasing groups, so that health plans can send a common set of signals about performance expectations to their provider networks; and
  • Using the exchange’s web portal to give consumers relevant and actionable information on plan and provider quality, as well as decision support tools that emphasize higher-value plans as consumers consider their plan choices.

As states work to meet the November deadline for the “exchange blueprints” that outline how they’ll operate their exchanges, they can look to regional health improvement alliances, such as those in the Robert Wood Johnson Foundation’s Aligning Forces for Quality (AF4Q) program, for lessons learned and insights from some of its leaders on ways to use exchanges to improve the quality of care. AF4Q is our signature effort to lift the overall quality of health care in 16 targeted communities and provide models for national reform.

What do exchanges have in common with regional health improvement alliances? A lot, it turns out.

Each must work to gain and maintain the support and cooperation of a diverse set of stakeholders that include the people who get care, provide care, and pay for care. Each has to select quality metrics important to consumers. Each has to present complex information on health care to consumers in ways that they can understand it, and use that knowledge to be better patients and consumers. And each can gain from aligning their efforts to drive high-value health care.

For those committed to working to ensure that every American has stable, affordable health care coverage, as we are at the Robert Wood Johnson Foundation, state health insurance exchanges represent a critical path forward in the nation’s effort to expand access to health insurance and improve the overall quality of care.

It is not surprising that the focus hasn’t been on quality heretofore. The core issues exchanges face are daunting—from building a modern information technology infrastructure, to mitigating adverse selection, to managing the stakeholder coalitions. And to be sure, exchanges’ first order of business is to attract health plans and enrollees. But the ability to help improve quality should also be given its due.

John Lumpkin  is the senior vice president and director of the Robert Wood Johnson Foundation’s Health Care Group. Learn more about the Foundation’s resources for exchanges.

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  • doc99

    By standardizing plans’ Essential Benefits, Exchanges may actually serve to limit, not expand choices. PPACA seems the anti-thesis of patient directed healthcare.

  • http://twitter.com/jrlumpkin John Lumpkin

    It is important to remember that the primary target
    for the exchanges are people who are currently uninsured or in the individual
    market. Today the ones who will become eligible for the subsidies
    have no affordable choices. Limited
    choice is better than no choice. Some
    employers may also shift some of their employees into the exchanges. It is also important to remember that these
    small business rarely have more than one choice available currently.