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Life Health > Health Insurance > Your Practice

CMS to public: What's "quality"?

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The Centers for Medicare & Medicaid Services (CMS) is asking members of the public to talk to it about health plan quality.

CMS has put out a “request for information” (RQI) seeking comments on how the new health insurance exchanges should manage health plan quality

The Patient Protection and Affordable Care Act of 2010 (PPACA) is supposed to set up a system of exchanges, or Web-based health insurance supermarkets, by late 2013.

Consumers and small employers are supposed to be able to use new PPACA tax credits to buy high-quality coverage through the exchanges, with the coverage to take effect Jan. 1, 2014.

States can choose whether to set up their own exchanges, let CMS’ parent — the U.S. Department of Health and Human Services (HHS) — provide exchange services for their residents, or share exchange duties with HHS.

In the RQI, which is set to appear in the Federal Register Tuesday, CMS officials pose a set of 15 questions about plan quality terminology and the practical aspects of plan quality measurement and reporting programs.

CMS officials start off by asking about current plan quality information sources, challenges facing existing plan quality measurement and tracking programs, and health care provider quality measurement and tracking programs.

“Do health insurance issuers monitor patient safety statistics, such as hospital acquired conditions and mortality outcomes, and if so, how?” CMS officials ask.

In a section on setting up quality programs for a health insurance exchange system, officials ask for ideas about which quality measures or measure sets are most relevant to the exchange marketplace, and whether there are any gaps in clinical measure sets that could create challenges for capturing experience in the exchange system.

Officials also ask about how an exchange should display a plan’s quality improvement information, and whether the approach a PPACA exchange uses should be different from the approach the Medicare Advantage program now uses to report “star rating” data.

“What are effective ways to display quality ratings that would be meaningful for exchange consumers and small employers, especially drawing on lessons learned from public reporting and transparency efforts that states and private entities use to display health care quality information?” officials ask.

Answers to the questions will be due 30 days after the official Federal Register publication date.

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