Quality has been top of focus across the health care world. Whether it be related to coverage, care or other consumer services, there has been ongoing movement to advance quality. Broadly, the definition of “quality” includes buzzwords we are all familiar with: access, cost effectiveness, cost transparency, value and high level of care. This edition of Health Policy News focuses on a range of developments relative to quality broadly. We highlight existing and new Federal quality of care and coverage initiatives, as well as a Federal initiative attempting to make quality reporting more coordinated.
Finally, we share recent regulatory proposals aimed at improving the quality of consumer assistance services.
Our intent for this edition of Health Policy News is simply to introduce this complicated health policy issue. As always, we invite you to contact us at HealthPolicyNews@pcgus.com for more information or if we can assist you in any way.
Current state of CMS quality rating programs
For Marketplace plans, quality is coming to the forefront as Quality CMS will be publicly displaying QHP quality rating information on HealthCare.gov Rating System (QRS) and Quality Improvement Strategy (QIS) requirements are rolled out for Qualified Health Plans (QHPs) starting in 2017. Click here to see what changes are coming for 2017.
CMS and AHIP announce alignment in physician quality measures
On February 16, 2016, CMS and America’s Health Insurance Plans (AHIP) announced multi-payer alignment and simplification of core quality measures to be used in calculating quality-based payments for seven physicians’ services specialties. Multi-payer alignment is expected to reduce the reporting burden for providers and to accelerate the nationwide shift to value-based payment. The seven specialties are: primary care (including quality measures for accountable care organizations and patient-centered medical homes), cardiology, gastroenterology, HIV and hepatitis C, oncology, obstetrics/gynecology, and orthopedics. Click here to read more.
Ensuring quality in consumer assistance services
The proposed Notice of Benefit and Payment Parameters for 2017 include a number of provisions seeking to improve the quality of assistance provided to individuals that purchase QHPs. If the proposals are finalized, enrollees will be able to get additional assistance from Navigators who will be trained regarding and required to provide assistance related to eligibility appeals, reconciliation of advanced premium tax credits and exemption applications and referrals to tax experts as needed. Navigators will have to complete training prior to undertaking any outreach and education activities and will face new requirements to target their outreach and assistance to vulnerable and underserved populations. The proposed regulations also put further limits on inducements for enrollment and impose additional reporting requirements. Click here to read more.
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Contributing Subject Matter Experts:
- Thomas Entrikin
- Lisa Kaplan Howe
- Margot Thistle