Simple-to-Understand Four-Star Rating System Gives Consumers New Tool, Lays Foundation for Robust Scoring System
SACRAMENTO, Calif. — California consumers can now get performance ratings on the vast majority of health insurance plans offered through Covered California™. The state health insurance exchange recently added a quality rating system (QRS) to its website to aid consumers in their selection of plans.
The QRS gives an easy-to-understand rating of one to four stars, with four stars being the highest score. The system is in place well ahead of the 2016 federal mandate and will be improved over the next two years as the exchange gets more comprehensive performance ratings for plans.
“After several months of open and constructive debate with consumer advocates, health plans and stakeholders, Covered California is now among the first exchanges in the nation to offer its consumers a quality rating system,” said Covered California Executive Director Peter V. Lee.
Many states, along with the federal exchange, are awaiting federal guidelines for establishing a rating system, but Covered California wanted to give existing scoring information beginning in 2014.
“We want to give consumers all the available tools to help them assess and choose plans in their regions,”
Lee said. “We are proud of the ratings in each of the exchange plans and recognize this is a preliminary look at exchange health plans.”
The ratings are based on reported experiences of members. Each health insurance plan is compared with results for health insurance plans across the western United States region.
A four-star plan means a plan placed in the top 25 percent of all rated plans. Three stars are given for those that landed in the 50- to 75-percent band, while a two-star plan means it scored in the 25- to 50-percent band of all plans. One star is given for those plans scoring in the bottom 25 percent.
Consumers can get QRS scores in their regions by visiting: https://www.CoveredCA.com/hbex/insurance-companies/qrs.html
The scores, from the nationally recognized Consumer Assessment of Healthcare Providers and Systems (CAHPS), asks plan members about access to care, including getting doctor appointments, tests and treatments; customer service; and medical care.
Consumers may access the quality ratings when they visitand browse health insurance plan options. The scores are displayed on the summary for each plan.
Covered California anticipates expanding its rating system to integrate the national standards when they are available, adding information on hospital, medical group and physician quality. The clinical performance scores will be based on claims data and patient records, in addition to member surveys about exchange plan services starting in 2014.
“These scores are just the beginning of a robust reporting and evaluation system planned for 2016,” said Lee.
About Covered California
Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans. With coverage starting in 2014, Covered California helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.
Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the Governor and the Legislature. For more information on Covered California, please visit www..com.