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New PPACA exchange reports: What’s in them for you?

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The Centers for Medicare & Medicaid Services (CMS) may collect more — and more detailed — performance information from the 16 state-based exchanges during the 2015 open enrollment period.

CMS — an arm of the U.S. Department of Health and Human Services (HHS) — has revealed the breadth and depth of the exchange information it intends to collect in a paperwork review filing.

The agency is not planning to publish the data itself, but it notes in a discussion of the information collection effort that the responses will not be confidential. That means individuals or companies may be able to get the data either by asking CMS for the data on an informal basis, or by filing a Freedom of Information Act (FOIA) request.

The information collection includes both quarterly reports and weekly reports. CMS has not yet made most of the kind of data obtained through the quarterly reports public, but it’s possible that the quarterly report data from the first open enrollment period, which lasted from Oct. 1, 2013, through mid-April 2014, could be obtained with a FOIA request.

For a look at the data treasures an agent or broker might find in the reports, read on.

Weekly report service statistics section

1. The weekly reports probably won’t include information about agents and brokers, but they might tell you how many consumers have such a hard time getting through to a call center rep that they hang up.

During the first open enrollment period, some state-based exchanges published information about matters such as website page views, website visits, mail volume, QHP enrollment volume, and call center wait time online.

Those exchanges also have published data on the “abandonment rate” — the percentage of callers who hang up before reaching either an automated assistance service or a live human.

During the upcoming open enrollment period, CMS wants all state-based exchanges to send it that data.

For agents and brokers who want to attract discouraged exchange callers, increases in abandonment rates might be a signal to increase marketing efforts.

Quarterly report - shows which employers have brokers

2. From the quarterly reports, you may find out what kinds of individuals and small groups are getting exchange QHP coverage with help from navigators or from other agents and brokers.

The quarterly reports are supposed to break down individual QHP buyers by income level and assistance channel used, and to break small group QHP users into categories based on group size.

The questionnaire for individual QHP buyers, for example, indicates whether consumers in the highest income bracket — for households with income of at least 400 percent of the federal poverty level (FPL) – used brokers or other types of exchange helpers, such as “in-person assisters” or “certified application counselors.”

Agents and brokers who see consumers in the top income category as good cross-selling prospects might use the figures to check whether they are doing a good job of reaching those prospects — or losing them and their purchasing power to the in-person assisters.

Exchange form - blank for complaints

3. You might be able to use complaint data in the weekly reports to find problems that nimble mammals like you were born to fix.

Some agents and brokers are focusing more on selling problem resolution services. The quarterly reports could be an indicator of how many problem-facing consumer advocacy service prospects an exchange is creating.