Affordable Care Act Marketplaces Can Contribute to Health System Transformation!
Jay Himmelstein, MD, MPH, is a professor of family medicine and community health and chief health policy strategist at the Center for Health Policy and Research at the University of Massachusetts Medical School (UMMS). He serves as a senior advisor to the UMMS Office of Policy and Technology, and is a senior Fellow in health policy at NORC, University of Chicago. Himmelstein is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program, where he worked on the health staff of Senator Edward Kennedy. This post is part of the “Health Care in 2014” series.
The nation's attention has focused in recent months on the politics and challenges related to the roll-out of state and federal health insurance marketplaces created by the Affordable Care Act (ACA). Despite website technical woes, significant numbers of Americans have already gained access to affordable insurance plans through the marketplaces and other provisions of the ACA, and it appears likely that the ‘marketplace’ concept will be successful over time in connecting consumers to health insurance and significantly decreasing the ranks of uninsured.
The better functioning marketplaces currently allow consumers to: 1) determine eligibility for subsidized health insurance, 2) use basic online shopping tools to compare and purchase health insurance plans based on four different "metallic tiers" (i.e., the platinum, gold, silver, and bronze tiers), and 3) make side-to-side comparisons between these plans on features such as deductibles, out-of-pocket cost limits, and number and proximity of doctors and hospitals. A few marketplaces also offer information about plan quality, the ability to search for health care providers and hospitals associated with specific plans, and rudimentary ‘cost calculators’ which estimate the total cost of plans inclusive of premiums, deductibles, and out-of-pocket costs.
In 2014, as the websites function more smoothly, I hope we can turn our attention to the potential for the ACA marketplaces to go beyond selling affordable insurance plans and toward contributing to the transformation of the health care delivery system and improved patient outcomes.
I see marketplaces evolving toward state-of-the-art online ‘shopping sites’ that can be as helpful to insurance purchasers as consumer sites such as Netflix and Amazon have become for selecting movies and buying consumer goods. Like Netflix, I can imagine a day when the marketplace website will make recommendations based on both my past health care expenditures, and on the experience of people like me who have a similar family size and range of health conditions. I envision a day when consumers have the ability to shop based on a wide range of options from a variety of ‘sellers,’ as in Amazon—combined with the tools to understand and evaluate options in detail through the use of objective product ratings and reviews.
More significantly, I look forward to the day when the marketplaces will promote transparency and a deeper understanding of the newer forms of health care delivery—such as patient-centered medical homes and Accountable Care Organizations (ACOs)—and help connect consumers not just to insurance plans, but to health care providers and delivery systems matched to their individual and family needs. When this occurs, the insurance marketplaces can truly become “market-makers” by driving patients to the most efficient and high quality delivery systems.
To be clear, purchasing insurance will never be as easy or as pleasant as selecting a movie or shopping for a book. Nevertheless, there is an opportunity to leverage marketplace technologies to assure that we are getting the coverage—and heath care—that we need. And by helping large numbers of consumers buy the highest quality plans utilizing the most efficient delivery systems, marketplaces can reinforce the path toward meaningful payment reform, rewarding efficient care and supporting better health outcomes.