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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