Tag: quality improvement

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

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.

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

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

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

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.

The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.