21-August-2015

In 2016, the Centers for Medicare and Medicaid Services (CMS) will begin gathering operational data from qualified health plan (QHP) issuers. As detailed in Inside Health Insurance Exchanges, carriers that sell QHPs will submit data including "information related to cost sharing for out-of-network services, retroactive claims denials, and rules and review processes for members who want to use non-formulary drugs." This data, as envisioned in the Affordable Care Act (ACA), could inform a "quality rating system" to help employers and consumers assess coverage options. According to Mike Adelberg, senior director at FaegreBD Consulting, this first round of data collection is merely a "cautious first step" in a process that could develop over several years.

"The transparency data eventually could facilitate consumer comparison tools, more thorough and empirical oversight by regulators or even active purchasing," Adelberg said. "This starts what will be a multi-year process. ... The end-point is impossible to know."

Adelberg recently wrote a client alert on the same topic.

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