Health Exchanges: Do They Pass the Transparency Test?

After a rocky start, the Affordable Care Act is at the beginning stages of "going online." Now that the health exchanges are online and seeing steady traffic, perhaps it is time to revisit a claim made by advocates that the exchanges promote transparency. One stated goal for the federal Health Insurance Marketplace is to ". . . bring new transparency to the health insurance market so that Americans will be able to compare plans based on price, quality, benefits and other important features."

Transparency for Shopping Based on what is provided at the New York health exchange, for example, there is indeed transparency of price and offering. Consumers accustomed to seeing this feature regularly at Amazon.com might consider product comparisons humdrum, but such direct apples-to-apples comparisons of health insurance plans were previously difficult, tedious and error-prone. A uniform basis for comparison is now available to consumers. 

First-time visitors to an insurance provider web site may not be aware of what is perhaps an exchange's most important feature: a clear list of providers not hosted by a third party with a financial stake in one of the insurers --such as broker-provided lists. Plus, standardized quotations that include annual anticipated costs to consumers -- copays, deductibles, etc. -- are now available, showing healthy, younger insureds as well as an older person being treated for diabetes. 

What about quality? That said, the exchanges do not make it easy to integrate quality data into these comparisons. While health care organization (e.g., hospitals) and physician quality is available from other sources, this still requires collecting available data from multiple sources. Consumers might even be willing to pay more for quality, but only if it can be provided with comparisons of like offerings, time frame and type of quality assessment. 

Bring on the data A gradual move toward transparency was also signaled by an August 2013 call for public comment by the Center for Medicare and Medicaid Services (CMS). Some data already released by CMS is being used for analytics, but the agency is also considering the release of physician reimbursement data. The call for public comment invited opinions on possible physician privacy aspects of the release, and whether such releases should be only in the aggregate, or at the individual physician level. In the call, CMS cited transparency as one of the objectives which it believes could help improve Medicare quality and reduce potential abuse.

CMS data has some distance to go before the data it has provided to health care analysts is readily digestible by citizens. The Sunlight Foundation lists a sampling if what is already possible using CMS data. But it appears that the agency may recognize some of the ground yet to be covered.