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Exchange plan grading rules get an incomplete

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The managers of Colorado’s state-based exchange want to see Centers for Medicare & Medicaid Services improve its evaluation system.

CMS is preparing to grade the quality of the public exchanges, and the quality of the plans they’re selling.

CMS has drafted a proposal that calls for it to collect information about 42 measures, including 29 measures of the quality of clinical care and 13 patient satisfaction measures.

Each plan would get a set of three “summary indicator” ratings and one overall rating.

The summary indicator ratings would be for clinical quality management, member experience, and plan efficiency affordability and management.

CMS would express the plans’ summary ratings and the overall ratings using a five-star scale.

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. 

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