May 2015


Exchanges Consider Decision Support Tools

States and Exchanges are exploring ways consumers can more easily compare what some consider a plethora of Qualified Health Plan (QHP) options available on Exchanges with tools that could narrow the total number of choices by several factors including anticipated or probable health services to be utilized by the consumer.

In the initial years of health insurance exchanges, online marketplaces have generally presented QHP options in an ascending order of premiums, a sequence some have argued only reinforces the tendency to choose health benefits coverage by price. As has been highlighted in the media and national discussions on ACA implementation, other cost features like copayments and deductibles can impact the total out-of-pocket costs a consumer can be expected (and may be surprised) to pay for health care services. Other plan features, such as narrow networks will also have an impact on experience with a consumer’s benefits. There is growing interest in technological functions that could account for these factors and guide consumers through the process and to a plan that best fits their needs—what are generally called “decision support tools.”

In March, CMS published a Request for Information (RFI) on the availability of tools that would help consumers evaluate different attributes of QHPs to identify those that best their needs. According to the RFI, CMS is evaluating the feasibility of adding features to that would utilize an out-of-pocket cost comparison tool from one or more organizations through a link that would redirect to the organization’s site. The earliest CMS would consider linking to these websites would be for the fall 2015 open enrollment period, when consumers are shopping for coverage that can start January 1, 2016. Longer-term, CMS potentially intends to integrate OOPC comparison functionality more directly into the consumer shopping experience on the website.

CMS’s interest in consumer decision support tools comes as many State-based Marketplaces (SBMs) are considering the addition of similar capabilities. For example, the Washington Health Benefit Exchange has been considering various consumer decision support tools created by external partners for the past few months and has an excellent presentation on the subject. MNsure, the Minnesota Exchange, requested proposals to provide consumer decision support tools. Specifically, MNsure seeks to offer access to a multi-faceted plan comparison tool beginning November 1, 2015 for private health insurance plans sold through the MNsure website.

As for dental, Exchanges have not yet indicated how dental plan options could be included within these tools; however, in a meeting with NADP and industry representatives, the CEO of Kevin Counihan expressed an interest in achieving some of the same goals of the technology for dental plans. The Commission on Advocacy Policy (CAP) and Exchange Policy Workgroup (EPW) will continue to evaluate the models being considered and provide insight to policymakers on the impacts to dental plans and consumers.

The interest in these tools from both public and private exchanges could be driven by a more broad movement toward direct-to-consumer sales and marketing of health insurance benefits. In its recent Plan Choice Challenge for program developers, the Robert Wood Johnson Foundation (RWJF) noted, “there are a number of plan choice tools that have been created by state and federal government, insurance brokers, private exchange managers, and other entities. While many of these tools have positive attributes, there is widespread recognition that consumer choice is not being sufficiently supported.” The RWJF Price Choice Challenge sought entries from developers and designers of decision support tools, which were recently highlighted in a public webinar. More on the Challenge and winners is available online here and serves as a great introduction to the innovative work being done in this area.



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