Data Collection and Use in the New Health Insurance Marketplaces

This brief by Health Information and the Law discusses the certification and accreditation requirements for ensuring the quality and value of health insurance plans sold in the new marketplaces created under the Affordable Care Act.

Insurers seeking to sell plans in the marketplaces must pass a two-part test before any products can be listed for sale:

  1. Each health plan must be certified as a “Qualified Health Plan” (QHP) by the applicable marketplace, with certification criteria spelled out in federal regulation and supplemented by any additional standards that may be imposed under state law.
  2. QHPs are required to meet quality accreditation standards and must implement a quality improvement strategy. These regulations require each product type offered by a QHP issuer (e.g., marketplace HMO, marketplace point of service, marketplace PPO) to be periodically reviewed and accredited by a quality accreditation entity recognized by HHS.

Authors point out that the requirements represent major advances in the transparency of health plan information for patients and consumers, and have the potential to have far-reaching effects on the overall quality and value of plans sold in the marketplaces.