Accessing Provider Directories and Formularies: CHIR Goes Sleuthing

We’re counting down again to Open Enrollment 3 and this year, all health plans must make accessing provider directories and formularies, or the list of covered prescription drugs, easy for consumers. This means consumers should be able to find this information on insurer website sites without creating an account or entering a policy number. CHIR’s Sandy Ahn flexes her investigative skills and looks to see how accessible this information really is.
The Next Big Thing in Network Adequacy: The NAIC Model Act

In November, the National Association of Insurance Commissioners (NAIC) will finalize the Network Adequacy Model Act – a draft bill designed to be used by states to enact provider access standards for private health insurance plans. Consumer representative Claire McAndrew explores what the act includes as well as areas for improvement.
Who’s got the Best Crystal Ball? Estimates for 2016 ACA Enrollment
Half of the Uninsured are Eligible for ACA Coverage
Big Data and Baby Steps: Two Very Different Approaches to Data Collection

Most Americans see the need for more data about health insurance and how it’s working for consumers, and the insurance industry itself seems to recognize the importance of collecting and analyzing data. But it’s not clear that our government regulators do. JoAnn Volk looks at the mismatch between what insurers are undertaking and what federal rules will require for data collection.
New Resource on Enrollment Now Available

As we draw nearer to the start of Open Enrollment 3, a new resource is available from the Centers for Medicare and Medicaid Services (CMS), the FFM and FF-SHOP Enrollment Manual. A complete guide of policy and operational information, the new Manual covers all topics related to eligibility and enrollment in the FFM and FF-SHOP. CHIR’s Sandy Ahn provides a quick summary of the new CMS resource.
Medicare Part D After Ten Years: Lessons for the Affordable Care Act
Post-Affordable Care Act Trends for Small Business Health Coverage: New Georgetown Report

The Affordable Care Act includes a number of market reforms affecting small business health insurance. CHIR researchers, in partnership with the Urban Institute and funded by the Robert Wood Johnson Foundation, interviewed stakeholders in 5 states about how the ACA is changing the small group market. In this blog post the authors discuss their findings.
The Experiences of State-Run Insurance Marketplaces That Use HealthCare.gov

Whether their exchange is state-based or federally facilitated, many state policymakers are seeking ways to realize the advantages of a state-run marketplace model while minimizing, so far as possible, the financial and operational burdens of building or maintaining one. In a new issue brief for The Commonwealth Fund, CHIR researchers explore the experiences of four states that established their own exchanges but have operated them with support from the federal HealthCare.gov eligibility and enrollment platform.