quality improvement

Questionable Quality Improvement Expenses Drive Proposed Changes to Medical Loss Ratio Reporting

Posted February 22, 2022 by CHIR Faculty

Under the Affordable Care Act, insurers must provide rebates to enrollees when their spending on clinical services and quality improvement, as a proportion of premium dollars, falls below a minimum threshold. Federal regulators have discovered some insurers are gaming the system by misallocating expenses or inflating their spending on providers. Karen Davenport takes a look at how this practice impacts consumers, and explains a new federal proposal to crack down on it.

NAIC Fall Meeting: As One Issue Winds Down, Another Rears Its Head

Posted December 10, 2015 by JoAnn Volk

At the NAIC’s most recent meeting, two issues stood out: the long-coming Network Adequacy Model Act was finally adopted, and regulators took another look at how insurers count costs for the Medical Loss Ratio. JoAnn Volk provides a summary of the action.

The Affordable Care Act’s Requirements for Quality Improvement in the Health Insurance Marketplaces: What Recent Federal Action Tells Us

Posted January 7, 2015 by

The Affordable Care Act sets out several requirements for the health insurance marketplaces to encourage insurers to improve quality and deliver better value coverage. Implementation of these provisions has been slowed by the focus on other, more urgent operational priorities, but recent federal rules put plans on notice that quality improvement standards, reporting requirements, and rankings are soon coming their way. Sabrina Corlette has this overview.

The Next Frontier: Insurance Marketplaces That Promote Quality Improvement

Posted August 21, 2014 by CHIR Faculty

While most state-based marketplaces in 2014 are rightly focused on the operational challenges of connecting people with coverage, over time technical improvements will allow them to prioritize providing better quality, more cost-effective care to enrollees. CHIR experts Sabrina Corlette and Sarah Dash, in their latest blog post for the Commonwealth Fund, discuss the opportunities and challenges for states working to implement the ACA’s quality improvement initiatives.

New Report Reviews State Action on Quality Improvement in State-Based Marketplaces

Posted August 1, 2014 by CHIR Faculty

The Affordable Care Act envisions that the new health insurance marketplaces will encourage plans to provide better quality, more cost-effective care. But achieving that is easier said than done. A recent report by CHIR faculty Sarah Dash and Sabrina Corlette charts action by the state-based marketplaces to achieve quality improvements and assesses future prospects. Ashley Williams provides an overview.

Putting the “Quality” in “Quality, Affordable Health Care”

Posted July 30, 2012 by CHIR Faculty

As exchange watchers count down to the December 14th deadline for states to officially choose a state-based exchange and submit their blueprints, Sarah Dash takes a look at news from the states and the feds – including progress on the quality requirements for exchanges.

Using Rate Review to Address Affordability of Coverage: Efforts in the States

Posted July 23, 2012 by

A handful of states are taking innovative approaches to the regulation of health insurance premium rates to help make coverage more affordable. Sabrina Corlette takes a look at these new strategies and the impact they could have on the cost of health care.