Measuring Quality in the Early Years of Health Insurance Exchanges

Objectives: To identify quality measures that health plans can reliably report during the early years of health insurance exchanges and over time, and to suggest strategies to increase the availability of quality results to use in rating and monitoring plans. Study Design: Projection of a set of measures available for public reporting based on prevalence and experience with health plans' reporting of the quality measures. Methods: For the quality measures included in the federal Initial Core Set of Adult Health Care Quality Measures for Medicaid-Eligible Adults, we looked at the proportion of people in the United States who would be eligible for each measure, and if available, the number of plans that in the past were not able to report reliable Healthcare Effectiveness Data and Information Set results to the National Committee for Quality Assurance because of low membership. We developed estimates of each state's exchange enrollment, and used the number of plans currently accredited in the state to estimate how many plans will offer coverage to determine the average exchange plan membership per state in 2014 and 2018. Results: In the early years exchange plans should be able to report a set of 14 preventive, chronic care, and access-to-service measures. As health plan membership grows through the years, more measures, including behavioral health, can be phased in. Conclusions: In 2015 and 2016, all exchanges should require plans to report the 14 measures and if needed, use suggested strategies to build the results for public reporting. Am J Manag Care. 2013;19(3):226-227