CMS to test pairing 5-star care ratings with marketplace plans in next open enrollment
The pilot will provide CMS with feedback on the best way to provide quality rating information to consumers.
In the 2017 open enrollment period, the Centers for Medicare and Medicaid Services will pilot a program on Healthcare.gov to pair results of a 5-star care rating with health plans on the federal marketplace.
Star ratings provide health plan quality information on such topics as how well physicians coordinate with enrollees and other physicians to provide the best care; whether the plan's network providers give members care that achieves the best results; and how other enrollees rate their doctors and the care they receive.
The pilot will provide CMS with feedback on the best way to provide quality rating information to consumers nationwide, according to Kevin Counihan, CEO of Healthcare.gov, and Patrick Conway, principal deputy administrator of CMS.
The pilot will begin in Michigan, Ohio, Pennsylvania, Virginia, and Wisconsin, states that use the Healthcare.gov platform. CMS selected these states because each has a large number of health plans participating, according to CMS.
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State-based marketplaces may also choose to display quality ratings information on their websites, CMS said.
The quality rating system, initiated in 2014, provides comparable information about health plans offered through the marketplace. It informs consumers on the quality of services and enrollee experience. It also assesses the overall patient and consumer experience.
The star ratings display is one of two innovations CMS plans to implement in six months, when the fourth year of open enrollment begins.
CMS is also offering consumers "Simple Choice plans."
These plans have a uniform set of features to allow consumers to compare fewer important factors such as monthly premiums and providers in the plan's network.
These plans emphasize coverage of core services before the consumer has reached his or her deductible.
Simple Choice plans have benefits that don't vary from plan to plan, so consumers can feel confident that they aren't losing benefits as they shop around, CMS said.
All of the Simple Choice plans will have a fixed deductible, out-of-pocket limits, and standard copayments within a metal tier of bronze, silver, gold and platinum.
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For certain services, such as a primary care appointment, a consumer would pay the same amount in any Simple Choice plan regardless of the metal tier, CMS said.
Simple Choice plans will be displayed prominently in Plan Compare, with clear visual cues that show consumers the plans that are easy to compare versus the ones that should be researched for differences.
Consumers will also be able to choose to see only these types of plans, if they want to a quick comparison.
Twitter: @SusanJMorse
