The Role of Exchanges in Quality Improvement

An Analysis of the Options

A new report funded by the Robert Wood Johnson Foundation identifies options states could pursue to use the health insurance exchanges to help drive health care quality improvement and delivery system reform. The Affordable Care Act (ACA) expands coverage under Medicaid and provides new coverage options through state-based insurance exchanges, with a goal of reducing the number of uninsured in this country by more than half. At the same time, the law aims to increase the quality and value of health care by targeting health services organization, delivery, and payment in Medicare and Medicaid.

Because an exchange can aggregate the purchasing power of individuals and small groups, it holds the potential to be an important mechanism for extending those quality and delivery system reforms beyond Medicare and Medicaid. The Georgetown University research team lays out a number of strategies for states to consider, including using the exchange's web portal to provide consumers with relevant and actionable information on both plan and provider quality. They conclude that states need to take steps now, developing the necessary infrastructure and governance, if they want to position their exchanges to undertake these quality improvement efforts moving forward.

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