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Health Insurance Marketplace Quality Initiatives

About the Marketplace Quality Initiatives

The Affordable Care Act (ACA) authorizes the creation of Health Insurance Marketplaces (Marketplaces) to help individuals and small employers shop for, select, and enroll in high quality, affordable private health plans. Only qualified health plans (QHPs) may be offered within the Marketplaces.

The ACA requires the U.S. Department of Health & Human Services (HHS) to develop quality data collection and reporting tools such as a Quality Rating System (QRS), a Quality Improvement Strategy (QIS) and an enrollee satisfaction survey system (ESS). The QRS, QIS, and ESS will inform consumer selection of a QHP, decisions about QHP certification, and the Federal and State Marketplaces monitoring of QHP performance. HHS intends a phased approach to QHP-specific quality reporting, beginning in 2016.

Webinar slides describing the QRS, the ESS, and the phased quality reporting process can be accessed in the Downloads section at the bottom of this page:

  • Marketplace Quality Update June 2014 – webinar slides that provide an overview of the Marketplace Quality Initiatives

Proposed Rules

There are no proposed rules for public comment at this time.

 

Quality Rating System (QRS)

About the QRS

Section 1311(c)(3) of the Affordable Care Act directs the HHS Secretary to develop a system that rates QHPs based on relative quality and price. It also requires Marketplaces to display QHP quality ratings on Marketplace websites to assist in consumer selection of QHPs.

Data Collection Guidelines

Documents describing the QRS requirements, technical specifications, and the QRS measures are available in the Downloads section at the bottom of this page. These documents include:

    • Issue Brief QRS Requirements for Issuers – overview of 2015 QRS Requirements for QHP Issuers
    • 2015 Beta Test of the Quality Rating System and Qualified Health Plan Enrollee Experience Survey: Technical Guidance for 2015 – specifies QRS and QHP Enrollee Survey requirements for QHP issuers offering coverage through the Marketplaces
    • 2015 QRS Measure Technical Specifications – describes what QHP issuers will need to do to collect and submit QRS measure data to CMS
    • QRS Beta Test Measures – outlines the quality measures that QHP issuers operating in all Marketplaces are required to report as part of the 2015 QRS beta test

Enrollee Experience Surveys

About the Enrollee Experience Surveys

Section 1311(c)(4) of ACA requires the HHS Secretary to develop an enrollee satisfaction survey system that assesses consumer experience with QHPs offered through a Marketplace. It also requires public display of information by each Marketplace to allow individuals to assess enrollee experience among comparable plans. Sections 1313 and 1321(a) of ACA provide the Secretary with general authority to establish standards and regulations related to Marketplaces and QHPs.

CMS is developing two consumer experience surveys to assess consumers’ and enrollees’ experiences with the Marketplaces and QHPs. Both surveys are scheduled for national implementation by CMS in 2016 and they are undergoing preliminary testing in 2014 and 2015.

For more information, see the following in the Downloads at the bottom of this page:

    • Issue Brief 1: Marketplace Survey and QHP Enrollee Survey Overview – provides a brief overview of the purpose and intent of the two surveys

Health Insurance Marketplace Survey

The Health Insurance Marketplace Survey (Marketplace Survey) is intended to obtain consumers’ perspectives on the services provided by Marketplaces.

See the following versions of the current survey in English, Spanish, and Chinese in the Downloads section at the bottom of this page:

    • Marketplace Survey 2014 Test (English) 
    • Marketplace Survey 2014 Test (Spanish) 
    • Marketplace Survey 2014 Test (Chinese) 

Marketplace Survey Improvement Guide

The Marketplace Survey Improvement Guide offers Marketplaces support in using results of the Marketplace Survey to improve the consumer experience. Available Spring 2015.

Reports for the Marketplace Survey            

Survey results for the 2014 test will be available in early 2015.

Technical Assistance Related to the Marketplace Survey

Through CMS funding, American Institutes for Research (AIR) is providing technical assistance to support Marketplaces in understanding, interpreting, and using the results of the survey.

Expert Usability Testing

Conducted during the 2014 open enrollment period, the purpose of the usability testing was to determine whether the State-Based Marketplace websites adopted principles for making a website usable for consumers and whether information about determining eligibility, comparing and choosing a health plan, and enrollment was easy to find.

Results from this assessment are available in the Downloads section at the bottom of this page:

        • Expert Website Usability Assessments of the State-Based Marketplace Websites

Consumer Usability Testing

Testing may be conducted during 2014/2015 open enrollment. A global report may be available in mid-2015.

Issue Briefs

Issue briefs on the following topics are available in the Downloads section at the bottom of this page:

        • Issue Brief 1: Marketplace Survey and QHP Enrollee Survey Overview 
        • Issue Brief 2: Technical Assistance—Marketplace Improvement Guide Advisory Group and Consumer Usability Testing 
        • Issue Brief 3: Including the SBMs in the Marketplace Survey Beta Test 

Webinars

There will likely be webinars for Marketplaces to discuss the results of the 2014 and 2015 tests.

Qualified Health Plan Enrollee Experience Survey

The Qualified Health Plan Enrollee Experience Survey (QHP Enrollee Survey) is intended to obtain enrollees’ perspectives on the services provided by QHPs offered through the Marketplaces.

For copies of the current survey in English, Spanish, and Chinese, see the following in the Downloads section at the bottom of this page:

    • QHP Enrollee Survey 2014 Test (English) 
    • QHP Enrollee Survey 2014 Test (Spanish) 
    • QHP Enrollee Survey 2014 Test (Chinese) 

Technical Assistance related to the QHP Enrollee Survey

More information about the survey questionnaire, measures, and technical assistance for participating survey vendors is available at: http://qhpcahps.cms.gov

Reports for the QHP Enrollee Survey

QHP Enrollee Survey reports will be available later in 2015.