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DC Exchange Takes Steps to Report on Quality of Health Plans Exchange Also Assures Financial Sustainability in 2015

Monday, June 10, 2013

The DC Health Benefit Exchange (HBX), at its last meeting on June 6, approved two consensus recommendations from stakeholder advisory working groups.  The first recommendation would put in place standards for monitoring, improving and public reporting on the quality of health plans offered in the Exchange. The second recommendation takes steps toward establishing financial sustainability for the Exchange in 2015 and beyond, after federal grant funding will cease.

The federal health law, known as the Affordable Care Act, requires all health plans sold in an Exchange Marketplace to be accredited by an independent, national organization and assessed for quality and consumer satisfaction. In turn, Marketplaces will be required to provide consumers with simple, easy-to-use information about the quality of the plans being sold.

Recognizing that it will take time to implement quality reporting, and consistent with federal guidance, the Quality Working Group took a phased approach to quality data collection. 

“Information about the quality of health plans will allow residents to make side-by-side comparisons of the options available to them, and make choices that best meet their health needs and the needs of their families,” said Mohammad Akhter, M.D., Chairman of the HBX Board. “By providing independent information about quality, we can help people get the care they need and to protect and improve their health.”

The Board approved a plan developed by an Advisory Working Group of DC residents representing diverse stakeholders including consumer and patient advocates, physicians, employers, and insurers.  The National Committee for Quality Assurance (a national accrediting organization that measures quality in health plans) also participated and contributed its expertise.  The group was chaired by Kate Sullivan Hare and vice chaired by Karen Johnson.

The recommendations include:

  • There continue to be public input into the development of quality standards;
  • Health plans be required to submit Quality Improvement Plans (QIPs) to the Exchange and that in the coming years, there be a standardized format for QIPs so that people can easily compare across plans;
  • In time for 2015 open enrollment, that the Exchange work with the health plans on the format for reporting off-the-shelf quality measures and accreditation status;
  • In 2015, the Exchange should explore developing DC Exchange-specific quality reporting requirements for the future.

“The Quality Working Group agreed to a reasonable approach to developing and presenting useful information to consumers, recognizing that such data analysis and reporting does not happen overnight.  They developed an aggressive plan for us to work toward,” said Mila Kofman, J.D., executive director of the HBX Executive Board.

The HBX Board also adopted recommendations from the Financial Sustainability Working Group – the group was chaired by Leighton Ku and vice chaired by Jill Thorpe – to identify ways the DC Marketplace can have sufficient resources to operate independently in 2015 and beyond. The Affordable Care Act provides states with federal grant funding in 2013 and 2014, but then requires them to be self-sustaining beginning January 1, 2015.

To address the issue of financial sustainability, the Financial Sustainability Working Group recommended using one the following ways for the Exchange to generate its own revenue:

  • Use a portion of city dollars collected from the District’s 2% premium tax and/or .3% Department of Insurance, Securities and Banking operating user fee to help support the Exchange; and
  • If it is not possible to use the existing revenue sources, or if additional resources are needed, it should be raised from an assessment of all health insurance premiums written in the District. If feasible, this should include assessments on reinsurance or stop loss premiums.

“The Financial Sustainability Working Group provided a thoughtful and balanced plan to ensure that the DC Exchange Marketplace becomes self-sustaining as required under federal law.  Our next step is to develop a sustainability report as required under our enabling legislation.  The report is due to the Mayor and Council by December 15,” said Mila Kofman, J.D., executive director of the HBX Executive Board.” 

Full reports from both Working Groups can be found on the DC HBX website at hbx.dc.gov/page/board-meeting-materials.