Exchange plan grading rules get an incomplete

CMS has developed a very comprehensive measure set that should have information to appeal to a broad range of consumers, staff members at Connect for Health Colorado say in a presentation on the CMS draft.

But CMS organized the measures in a confusing way, exchange managers claim.

If CMS wants consumers to be able to use the data, it will either have to simplify the way it organizes the metrics, or come up with a way consumers can search for data using language consumers can understand, exchange managers say.

Another problem, exchange managers say, is that CMS is talking about basing the average score on the median plan performance, without directly tying it to how well the plans are doing, in an absolute sense.

If all plans are doing poorly on an indicator, such as getting patients with diabetes to have annual eye exams, a plan could end up with a high star rating, even though it’s really doing what consumers would think of as a poor job on that indicator, exchange managers say. 

See also:

• Exchange plans to get reviews
• PPACA plans lurch toward servicing stage
• What if producers and FFEs break up?