For decades, individuals and families shopping for health insurance have been unable to easily lay their hands on the most basic information on costs and coverage that they need to make an informed choice. That's about to change.
Bill Corr, deputy secretary of the U.S. Department of Health and Human Services said Tuesday that his agency has unlocked a vault of federal insurance data now available on the website Healthcare.gov, so that any organization or person with the technical know-how can access and compare data on the costs and benefits of thousands of insurance plans.
U.S. News & World Report is already working hard to turn this trove of data into a tool consumers can use to compare plans and select from the best.
“When consumers can easily compare plans,” Corr said, “insurance companies will no longer be able to hide behind the fine print.” He made his announcement in Washington, D.C., at the Health Data Initiative Forum. That event, better known by the nickname Health Datapalooza, aims to showcase new applications that employ data from government and other sources. It ends today.
Early this year, we stated our intention to add health insurance--specifically, plans sold by insurers directly to individuals and families--to the roster of healthcare products and services that U.S. News evaluates on behalf of consumers. Individuals and families seeking to purchase health insurance on their own need to know which plans best fit their budget and coverage requirements. We have now developed a way to help them answer that question. We aim to launch U.S. News Best Health Insurance Plans this August.
Best Health Insurance Plans will draw data from the database Corr spoke of, which also underpins the federal government’s Plan Finder tool on HealthCare.gov. We've identified 31 measures that paint a picture of each plan’s coverage—not just whether a plan pays for a service such as prescription drugs or outpatient surgery, but what strings may be attached. U.S. News will score plans on their completeness of coverage as well as the affordability of their stated premium relative to comparable plans.
Much of our methodology will examine a health plan’s coverage of certain benefits deemed “essential” under the Affordable Care Act. (The act names 10 services, but we will focus on those that are both crucial and most subject to variations in coverage from plan to plan.) Among these are outpatient surgery, emergency care, maternity and newborn care and coverage of rehabilitative and mental health services.
Most plans feature a confusing array of costs, covered services, and limitations. Settling on a definitive list of variables to apply to each plan and deciding how to weight the individual elements wasn't easy. There’s no such thing as one-size-fits-all health coverage. A plan that makes sense for a single healthy 30-year-old may not be the best choice for a family of four with a child prone to health problems.
We tackled the challenge in several ways. For consumers looking for a quick assessment of available plans, we’ve created a methodology for rating each plan based on its scope of coverage and benefits and its typical cost in terms of premium. For those willing to go a bit deeper in their research, we've committed to creating a user-friendly web interface that allows users to compare plans item by item, detail by detail.
We also think it’s important to reward plans that meet a “truth in description” standard we have created. It speaks to annual out-of-pocket expenses. Plans display an “out-of-pocket maximum” cost figure in brochures, on their web pages, and in the government’s Plan Finder. The label seems to convey a clear message that the dollar amount represents the limit on how much consumers will have to shell out for healthcare during the year in addition to their monthly premiums.
However, “out-of-pocket maximum” doesn't mean that at all. Many plans omit one or more of the other ways policyholders pay more than the stated amount through a deductible, copays, and coinsurance. A plan only gets full credit in our “transparency” measure if all three of these cost extenders are built into the annual out-of pocket limit.
We would like to evaluate plans on clinical quality, too: the extent to which members receive appropriate medical care. Measures that would enable that sort of analysis, unfortunately, do not exist for individual health plans. But states are required by the Affordable Care Act to develop them by 2014, potentially opening an avenue for us to pursue this goal.
The National Committee for Quality Assurance has developed a set of quality measures for group plans, which it accredits, but individual plans are neither accredited nor do they submit data that demonstrates their ability to keep members healthy. Nor is information about member satisfaction available for individual plans, as it is for accredited group plans through the NCQA’s Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores.
When quality information comes on line, we will evaluate it and incorporate it into Best Health Insurance Plans, as it is—if we think that’s best—or as part of a new methodology that we believe will better meet users’ needs. Stay tuned.