NRHI has urged the Centers for Medicare and Medicaid Services (CMS) to ensure that requirements related to quality measurement and quality improvement activities of Qualified Health Plans participating in Health Benefit Exchanges support the quality measurement and quality improvement activities of Regional Health Improvement Collaboratives. More specifically, NRHI recommended that:
- Health plans should be measured on the extent to which they (a) have high-value healthcare providers in their networks, with high-value providers identified based on quality and cost measures derived from multi-payer data and published by multi-stakeholder Collaboratives; (b) contribute data to multi-stakeholder Collaboratives to enable them to measure the quality and cost of care; (c) enable and encourage their members to use high-value providers through value-based benefit designs that rely on the Collaboratives’ cost and quality measures; and (d) support community multi-stakeholder initiatives designed to improve the quality and cost of healthcare, including multi-payer provider payment reforms.
- The highest level of recognition in Exchanges be given to health insurance issuers that participate in multi-payer quality measurement and improvement initiatives.
- Where there is an existing community quality measurement and reporting and/or quality improvement strategy that has been developed by a multi-stakeholder Regional Health Improvement Collaborative, the issuer of a Qualified Health Plan should be encouraged or required to support that existing strategy and to participate in programs developed to achieve the goals of the strategy.