Covered California will offer quality ratings for health plans

10/24/2013 7:56 PM

11/08/2013 2:04 PM

Consumers shopping for health care on California’s new exchange will see quality ratings for insurance plans as soon as next year.

The direction by the Covered California board Thursday came after three large insurers criticized a staff recommendation to delay moving ahead until more information could be gathered about the current plans.

Covered California Executive Director Peter V. Lee said the agency was concerned that offering ratings information for only a small percentage of the plans would be misinterpreted by consumers and dissuade people from enrolling.

“The reason I have wrestled so much with this recommendation is that the three plans – Western Health, Kaiser and Sharp – have done good quality work and I would like to reward that,” Lee said. “I don’t want to reward that at the expense of having fewer people enroll in Covered California and misleading them into thinking those other plans and other options are bad quality.”

His recommendation called for implementing the ratings system for all plans offered on the exchange during open enrollment in 2015.

But representatives from Kaiser, Sharp Health Plan and Western Health Advantage contended it was unfair to keep consumers in the dark when quality information was available for their consideration. Garry Maisel, president and chief executive of Western Health Advantage, said Thursday that for months price has been discussed as the incentive or lure for potential customers.

“But I think that quality has got to be the issue that closes the deal,” Maisel said. “Because if this is not all about quality in the end then Covered California is going to fail and the federal exchange is going to fail.”

Consumers Union and a trio of health policy groups suggested other states also have grappled with the same problem by using less comprehensive ratings to include more plans.

The groups suggested the exchange also could simply provide caveat language such as “Not rated yet – new carrier” or “In progress” for unrated plans.

Representatives for Blue Shield of California, Health Net and Anthem Blue Cross supported the staff proposal, contending that if the purpose of providing quality ratings is about giving consumers comprehensive information about all of the options in the exchange then the best approach is to wait until all plans can be assessed. Allison Barnett, director of government relations at Anthem, said health providers want consumers to have the best quality data they can, but they also want it to be current and consistent.

But the five-member board ultimately opted for more disclosure.

“I feel pretty strongly about including as much data as we have access to on quality and doing it now,” said Susan Kennedy, a board member for the exchange. “I understand the argument about misinterpretation and fairness, but I think we have to err on the side of being fair to consumers first and foremost.”

Kennedy said customers could just as easily misinterpret the data if the insurance marketplace continued to only include price and not quality.

“The absence of quality data is a data point in and of itself that I have a right to know,” she added. “And if I want to take that risk, if quality is important to me, I have a right to choose to go with a plan that has a network for which there is not enough data to know what their quality rating is.”

Oregon, Maryland, Colorado, Connecticut and Massachusetts provide quality ratings. The federal exchange does not.

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