Health insurance exchange design could affect the value of the health insurance services consumers buy, health plan quality experts say.
The National Committee for Quality Assurance (NCQA), Washington, makes that point in a presentation prepared for the Exchanges Subgroup at the National Association of Insurance Commissioners (NAIC), Kansas City, Mo.
NCQA President Margaret O’Kane is set to make a presentation to the subgroup in Philadelphia Aug. 31, at the NAIC’s summer meeting.
The subgroup has included a copy of the NCQA presentation, which covers the relationship between exchange quality and exchange savings, along with a summer meeting session agenda.
The subgroup is helping federal agencies, the NAIC and state insurance regulators implement the health insurance exchange provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA).
The provisions call for states to help set up state-run exchanges for individuals and small groups by 2014. In states that do not set up exchanges, the federal government will provide exchange services, if the provisions take effect as written and work as drafters expect.
Exchange builders can choose from a variety of approaches to managing the exchanges, deciding which products can be sold through the exchanges, and setting exchange rules.
The construction of the exchanges represents an opportunity to drive a value agenda and “‘nudge’ consumers towards best value options” through what the NCQA calls “choice architecture,” the NCQA says in the exchange quality presentations.
Choice architecture could include strategies such as building portal displays that array cost and quality information together or finding other ways to point users in the direction of high-value options, the NCQA says.
Another element of choice architecture will be the decision-support tools an exchange includes, the NCQA says.
The decision-support tools could range from a static report card listing and comparing plans to an interactive filter that helps consumers sift through plan information to find the plans that meet their criteria.
Exchange managers should consider highlighting plans that offer good coverage from chronic conditions and coverage for maintenance medications, and they should get and post standardized performance data, the NCQA says.
The NCQA believes its own health plan accreditation program and program data could useful to exchange programs, the NCQA says.