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Health Insurance Exchanges: Improving Health Care Access And Quality



July 26th, 2012

When the Oregon Health Insurance Exchange began planning how to offer comparative information about health care insurance options, the organization turned to the Oregon Health Care Quality Corporation, a nonprofit regional health improvement alliance that compiles reports on the quality of care provided by Oregon hospitals and physicians.

Why would a health insurance exchange, which gives people information about health insurance options, turn for help to a regional health improvement alliance that focuses on the quality of health care in hospitals and doctors’ offices? Because the two have a lot in common.

Each has to engage important stakeholders in their community, including local health plans, providers, purchasers, and patients. Each has to establish criteria and selection processes for quality measures. Each has to display complex data to consumers in a way they can understand and use to make informed choices about their care. And each works to foster quality and value in the local health care system.

Collaborations Between State Exchanges And The Aligning Forces For Quality Program

The collaboration between the Oregon Health Care Quality Corporation and the Oregon Health Insurance Exchange stems from requirements by the Affordable Care Act (ACA) and guidance from HHS for exchanges to not only expand access to care, but also to improve its quality and value. The ACA requires exchanges to measure the quality of health plans and insurers, survey plan enrollees on their satisfaction with their coverage, and publish quality and satisfaction data online. Exchanges are also tasked with overseeing quality improvement strategies across insurers and ensuring that qualified health plans meet quality requirements.

The Oregon exchange won bipartisan support from legislators when it was approved in 2011. The Oregon Legislature established the exchange as an independent, public corporation that will provide health coverage options, as well as inform and assist the people and businesses that obtain health insurance via the exchange.

To that end, the Oregon Health Insurance Exchange contracted with the Oregon Health Care Quality Corporation, which also is the home of the Robert Wood Johnson Foundation’s Aligning Forces for Quality (AF4Q) program in Oregon. AF4Q is RWJF’s signature effort to improve the overall quality of health care in 16 communities and provide local models that can help propel national reform. The Oregon exchange saw benefit in the alliance’s experience working with stakeholders to ensure its statewide public reports on the performance of doctors’ offices and medical groups are aligned with rapidly moving health transformation.

“In many communities, the alliances have already been producing quality measures at provider levels, at plan levels, and at community levels—so they are in effect experts in this work,” stated Mylia Christensen, the executive director of the Oregon Health Care Quality Corporation.

Similarly, Minnesota Community Measurement, the AF4Q alliance in Minnesota, is assisting the Minnesota Health Insurance Exchange Advisory Task Force in selecting measures for evaluating cost, quality, and patient satisfaction for health plans and providers. Jim Chase, president of Minnesota Community Measurement, is participating in the exchange’s Measurement and Reporting Work Group to offer knowledge from the organization’s experience choosing metrics to evaluate providers across Minnesota. The work group will also decide how the exchange’s online information on health plans will be displayed to best promote value-based decisions to consumers as they make choices about their providers and health plans.

All AF4Q alliances use web-based reports to display their data on the quality of care provided by hospitals and physicians. Over time, we’ve come a long way and learned a lot about making these reports more salient and consumer-friendly, but we still have a ways to go to make sure patients can easily find, interpret, and use these reports make better choices about their care. Like the alliances, exchanges will need to develop consumer-friendly websites that display data using navigation and sorting aids so that users can easily find and evaluate the information that is most important to them.

Informing consumer choice is only one way exchanges can drive quality improvement. They are also in a crucial position to align quality improvement and reimbursement strategies across health purchasers. By working with other government purchasers such as Medicaid and state employees’ insurance plans, and by reaching out to private health insurance plans, they can work to standardize performance measures and quality-based reimbursement incentives to push for improvements in the efficiency and quality of care. Some AF4Q alliances, like the Puget Sound Health Alliance in Seattle, are already publishing reports comparing the performance of health plans in the region to promote quality-based purchasing priorities using the National Business Coalition on Health’s eValu8 tool.

Lessons From AF4Q

The Foundation recently pulled together relevant lessons from AF4Q in a brief report that offers an overview on how exchanges can provide consumers with information about the quality of care, align quality improvement and reimbursement strategies with other purchasers, and adopt best practices to help consumers better understand their options. The report includes multiple links to papers, videos, and other tools.

“I think the bottom line for Aligning Forces, for the Oregon Health Care Quality Corporation—and in our case, the Oregon Health Insurance Exchange—is that this is a wonderful opportunity to provide both quality and cost information and to have a new marketplace for individuals and small businesses to have insurance. I think we are taking a leadership role in terms of common measures and quality expertise, and we are delighted to be a part of this process,” stated Christensen.

Achieving alignment won’t be easy. It requires getting the people who get care, give care, and pay for care at the same table to work for the common good. It is not easy, but Aligning Forces for Quality teaches us that it can be done.

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