The Affordable Care Act envisions health insurance marketplaces not just as gateways to health insurance coverage and mechanisms for people to receive financial assistance, but also as key market actors to encourage health plans – and through them providers – to deliver high quality care in a cost-effective way. As such, it requires marketplaces to help people compare  plans based on quality and value, set common quality improvement requirements for participating health plans, and collect quality and cost data to inform improvements.

These important activities are in addition to the other essential marketplace functions outlined under the law: running an eligibility and enrollment system, providing certification and oversight of health plans, and ensuring financial accountability. So it’s not surprising that federal regulators decided early on to delay implementation of some of the new quality reforms in the law so they could focus on core operational issues.

But that didn’t stop some states from recognizing the potential of the marketplaces to drive quality improvement and moving forward on their own. In their latest issue brief for The Commonwealth Fund, Sarah Dash, Sabrina Corlette, and Amy Thomas review actions taken by state-based marketplaces to implement the Affordable Care Act’s quality requirements, including efforts to improve health care quality, in three primary areas. They find that thirteen states are using health insurance marketplaces to promote quality improvement goals. These findings suggest that although technical and operational challenges remain, marketplaces have the potential to drive system-wide reform in health care delivery.

To read the issue brief, Implementing the Affordable Care Act: State Action on Quality Improvement in State-Based Marketplaces, visit The Commonwealth Fund website.