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The Department of Health and Human Services (HHS) published the attached notice in the Federal Register on Nov. 19, proposing a quality rating system (QRS) for qualified health plans (QHPs) offered through health insurance exchanges. The Affordable Care Act requires HHS to create a system enabling consumers to compare QHPs based on relative quality, price and enrollee satisfaction. The notice outlines a proposed methodology for selecting QRS measures, organizing such measures into broad categories meaningful to consumers (e.g., care coordination, preventive services, patient safety, etc.), and calculating statistically valid global ratings for each QHP (as is now done under the Medicare Advantage 5-star rating system).
HHS identifies 42 measures for family/adult self-only coverage and 25 measures for child-only coverage. Of the adult measures, 76 percent have been endorsed by the National Quality Forum (NQF); 83 percent are already in use under Medicare, Medicaid, the Federal Employees Health Benefits program and leading state programs, such as the California Healthcare Quality Report Card and New York’s Electronic Quality Assurance Reporting Requirements; and the remainder are used in private accreditation and quality ranking programs, including the Consumer Reports Health Plan Rankings. HHS has already finalized regulations that direct exchanges to oversee implementation of the QRS and require health insurance issuers to report health care quality data to exchanges. However, HHS is requesting comments on the proposed QRS measures, organization of measures, the rating methodology (including peer groupings, statistical sampling and scoring methods), ensuring the integrity of ratings, and priorities for future measure development. Comments are due Jan. 21, 2014.
