Consumers will look for quality in exchange markets

November 1, 2013

Industry metrics must move beyond HEDIS measures

WITH THE LACKLUSTER launch of the insurance marketplaces around the country, undoubtedly many Americans are skeptical of not just the enrollment platforms, but the health plans as well. In time, plans can expect a greater demand for quality information.

“People will ideally want to shop not just on price but on quality so the more things we portray side by side, the better,” says Joel Ario, managing director for Manatt Health Solutions, former director of exchanges at the Department of Health and Human Services.

Ario says it’s a documented fact that consumers will gravitate toward price in their buying decisions if price is presented to them first, while underestimating the importance of quality information if it is presented as a secondary variable. He advises that quality comparisons should be presented up front in the exchanges.

“We’re going to be in a much more transparent world,” he says. “The quality questions will be on the table more than they have in the past, and I think we’ll see a surge in improvement in quality.”

The exchanges will help forward the agenda for plan performance and provider performance, he says.

“As the exchange marketplaces mature, it is possible that, like Medicare with star ratings, states will have a greater role in determining ratings, and as such, greater influence on consumer choices,” says Jaime Estupinan, partner with Booz & Co., in an email to Managed Healthcare Executive.

Estupinan also says that consumers are relying more on other consumers for purchasing advice. Websites that rate goods and services are growing in popularity, driven by technology and demographic shifts. But websites aren’t the only option.

Plans that open storefront centers and offer in-person assistance with direct enrollment have an opportunity to become the trusted source of quality information, according to Ario. The newly enrolled will most likely look to navigators in the communities where they live. For group plans, agents and brokers will continue to be resources for decision making.

The future will undoubtedly advance quality measurement and reporting to consumers in a variety of formats among several sources.

“We will have to move beyond HEDIS measures,” Ario says. “They no longer distinguish between plans. Most plans score more or less in the same range.”

But for the time being, consumers on the exchanges have the metal level and the price as their primary input to evaluate their plan choices.

Estupinan says insurers are renewing their focus on readiness for January 1, including any refinements to the care activities targeted at their exchanges members.

“Some market leaders are surprised to find that they have a low-cost position in their market’s exchanges,” he says. “Other market leaders have found that there are competitors with up to 20% lower pricing. Some are beginning to think about their product strategies for next time around, considering, for example, whether any market share gains by lower priced products will have ‘stickiness’ for next year.”

-Julie Miller