Washington Health Benefit Exchange
Transcript of Washington Health Benefit Exchange
Washington Health Benefit Exchange
CONSUMER RATING SYSTEM UPDATEPolicy Committee Meeting
July 29, 2013
CHRISTINE GIBERTSENIOR POLICY ANALYST
CONSUMER RATING SYSTEM AND QUALITY REPORTING FOR QHPS
▪ Board decision last fall on addressing quality in 2016
▪ Consumer Rating System and quality areas in QHP certification (quality measures/quality improvement) being addressed together
▪ Same data will be used for both
▪ Maximize efficiency for carriers and Exchange
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QUALITY INFORMATION 2014 - 2015
▪ Quality Improvement Strategy certification criterion for QHPs
▪ Issuers document their strategies to:
▪ Improve health outcomes
▪ Prevent hospital readmissions
▪ Improve patient safety and reducing medical errors
▪ Improve wellness and health promotion
▪ Reduce health and healthcare disparities
▪ Consumers view information using the Plan Comparison feature of Healthplanfinder
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CONSUMER RATING SYSTEM IN 2016
▪ Add value for consumers making decisions
▪ Provide apples to apples comparisons
▪ Focus on three areas of quality measurement
▪ Prevention
▪ Care Management
▪ Enrollee Satisfaction
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CONSUMER RATING SYSTEM IN 2016
▪ Board chose to use two data sources
▪ HEDIS measures
▪ CAHPS data
Area of Quality Measurement Data Source
Prevention HEDIS Data
Care management HEDIS Data
Enrollee satisfaction CAHPS Data
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HEDIS/CAHPS DATA
▪ Standardized data
▪ Market specific
▪ HEDIS utilizes NCQA data and systems, CAHPS is federally developed
▪ Information to make national comparisons
▪ Most health plans already participate in collecting this data
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TIMELINE FOR IMPLEMENTATION
▪ 2014
▪ Data from 2014 plan year will be reported by QHPs in early 2015
▪ Design how data will be displayed to consumers
▪ 2015
▪ Receive 2014 data in mid-2015
▪ Analyze and synthesize data
▪ Display data for consumers to use during open enrollment for 2016 coverage – ready by October 2015
▪ 2016+
▪ Consumer Rating System in place and part of QHP shopping experience
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RECOMMENDED QUALITY MEASURES
▪ Measures of prevention, care management, and enrollee satisfaction
▪ 25 recommended measures
▪ All HEDIS and CAHPS
▪ Informed by NCQA recommended measures for Exchanges and measures chosen by Oregon, California, and Colorado Exchanges
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RECOMMENDED QUALITY MEASURES
▪ Diverse group of measures addressing broad range of health issues
▪ Wellness and prevention
▪ Chronic illness
▪ Mental and behavioral health
▪ Medication management
▪ Patient experience
▪ Address health care experiences across a broad age spectrum
▪ E.g., well-child visits and flu shots for adults ages 50-64
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RECOMMENDED QUALITY MEASURES -PREVENTION
Suggested Washington State Measures NCQA* Oregon California Colorado
Prevention (HEDIS)
Breast cancer screening
Cervical cancer screening
Colorectal cancer screening
Flu shots for adults ages 50-64
Medical assistance with smoking and tobacco use cessation
Adult BMI assessment
Childhood immunization status
Prenatal and postpartum care
Well-child visits in the first 15 months of life
Adolescent well-care visits
Weight assessment and counseling for nutrition and physical activity for children/adolescents
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*NCQA recommended quality measures for use by state-based exchanges, reported in Measuring Quality in the Early Years of Health Insurance Exchanges, Am J Manag Care, 2013;19(3):220-227.
RECOMMENDED QUALITY MEASURES –CARE MANAGEMENT
Suggested Washington State Measures NCQA* Oregon California Colorado
Care Management (HEDIS)
Plan all-cause readmission
Controlling high blood pressure
Cholesterol management for patients with cardiovascular conditions
Comprehensive diabetes care: LDL-C screening
Comprehensive diabetes care: A1C testing
Medication management for people with asthma
Monitoring patients on persistent medications
Engagement of alcohol/drug dependence
Antidepressant medication management
Follow-up after hospitalization for mental illness
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*NCQA recommended quality measures for use by state-based exchanges, reported in Measuring Quality in the Early Years of Health Insurance Exchanges, Am J Manag Care, 2013;19(3):220-227.
RECOMMENDED QUALITY MEASURES –ENROLLEE SATISFACTION
Suggested Washington State Measures NCQA* Oregon California Colorado
Enrollee Satisfaction (CAHPS)
Overall rating of health care quality
Customer service: Information
Customer service: Courtesy and respect
Getting needed care without delay
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*NCQA recommended quality measures for use by state-based exchanges, reported in Measuring Quality in the Early Years of Health Insurance Exchanges, Am J Manag Care, 2013;19(3):220-227.
NCQA did not recommend collection of any CAHPS data by state-based exchanges for the initial years.
NEXT STEPS
▪ Exchange to hire a vendor to collect and analyze HEDIS and CAHPS data, and translate it into a user friendly format
▪ Determine how the information will be displayed
▪ Implement a more comprehensive consumer rating system in later versions when more comparative health plan data is available
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