Quality ratings, consumer information and the early years of the Marketplaces

CMS is working to develop a quality rating system to be used in 2016 that will reflect health plans’ experience taking care of people buying coverage in Marketplaces. As the Healthcare Benefit/Insurance Marketplaces are launched in 2014, states may want to share available information about health plan quality in the form of:

  • Accreditation status,
  • Performance on clinical measures, such as childhood immunizations, preventive screenings for cancer and effective monitoring and management of chronic conditions such as diabetes, and
  • Data on patients’ experience with their care and their health plan.

Many states have a long history of putting together report cards on health plan performance, and these report cards are a useful resource to share with consumers even if they do not reflect specific experiences in the Marketplaces. We do not recommend putting Medicaid and Commercial data into one rating.

NCQA recognizes that not all health plans have made information on quality publicly available, and some are new market entrants. That said, it helps consumers to have some information available on the quality of care from health plans in the state; consumers can understand that some plans are new and will not have this data available.

Consumers deserve to have plan quality information as they navigate through the decision process. While not perfect, existing quality data can be a resource to help consumers choose a plan until the national measurement system is ready. States making this type of information available should be clear that it does not reflect Marketplace plan performance, and that the information is for the Medicaid or Commercial (as relevant) market for that particular state.

For more information, contact healthexchanges@ncqa.org. Read more about Quality Measures for Marketplaces