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

2

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

3

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

4

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

5

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

6

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

7

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

8

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

9

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

10

*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

11

*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

12

*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

13