Federal Government Shares Consumers' CHECKBOOK's Recommendations for a Health Plan Comparison Tool for Exchanges

Recommendations Are Intended to Guide State and Federal Leaders in Designing Health Insurance Exchanges That Help Consumers Make Best Plan Choices

WASHINGTON, Dec. 8, 2011 /PRNewswire-USNewswire/ -- The Federal government's Center for Consumer Information and Insurance Oversight (CCIIO) has just released a document prepared by Consumers' CHECKBOOK/Center for the Study of Services (CHECKBOOK/CSS) setting out key Health Insurance Exchange features that will enable consumers to choose the health plans that will best meet their needs and preferences.

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This is the first document to be shared through the "Consumer Web Best Practices" area of an online resource at the U.S. Department of Health and Human Services (HHS).  It is available at https://calt.hhs.gov/sf/go/projects.se_portal_sandbox/docman.root.cms_model_portal.consumer_web_best_practices, accessible by state and Federal officials. A similar document is available to the public at www.checkbook.org/exchange.

The document's recommendations are based on the nonprofit CHECKBOOK/CSS organization's experience for the past 33 years producing CHECKBOOK's Guide to Health Plans for Federal Employees and Retirees. This Guide is a plan comparison tool that evaluates the cost and quality of the 200-plus health plans serving the 8 million consumers insured through the nation's largest "exchange." For years, many employees purchased printed versions or online access to the Guide and in recent years many Federal agencies have purchased online access in bulk for their employees (HHS, Labor, IRS, Federal Reserve, U.S. Senate, etc.).

Providing its Guide to help consumers choose plans has given CHECKBOOK/CSS an opportunity to learn what is needed in a health plan comparison tool and to learn how best to address the practical issues of tool feasibility, cost, and implementation.  CHECKBOOK/CSS has observed usage patterns, surveyed thousands of users, and answered insurance questions in Q&A forums. And its experts have made a practice of actually meeting personally each year with individuals and small groups to provide personal advice and continually learn about consumers' goals and assumptions in selecting insurance plans.  In addition, CHECKBOOK/CSS regularly seeks feedback from the health plans being evaluated.

Now CHECKBOOK/CSS has created a model plan comparison tool that Exchanges can adapt for themselves or can have CHECKBOOK implement for them. This tool incorporates the features recommended in the document CCIIO is now sharing.

"Private and public resources, where they exist, to help consumers choose among health plans are generally nowhere near as helpful as they could be," said Robert Krughoff, CHECKBOOK/CSS's president. "The insurance Exchanges under health reform can do better.  Our recommendations are intended to help make that happen."

Whoever builds a plan comparison tool, there are many features such a tool should have, according to CHECKBOOK/CSS, and the document CCIIO is now sharing describes these features.  They include—

• Comparison of insurance value—showing premium plus an actuarial estimate of average out-of-pocket cost, including both known and unpredictable expenses—for someone of the user's age, family size, and other characteristics—not just a description of deductibles, co-pays, and other coverage terms—and not just an estimate of out-of-pocket costs for known or predictable expenses.
• Estimates of out-of-pocket cost in really bad years and the likelihood of having such years.
• An Exchange-wide provider directory so that the user can quickly see which plans have his or her preferred providers.
• Information on the quality of available doctors and other providers.
• Measures of each plan's quality, including its health promotion programs, with the ability for the user to focus on the quality dimensions of greatest interest to him or her.
• Descriptions and assessments of the value of special plan features such as dental coverage, vision coverage, or a fitness club benefit.
• Highlighting of any unusual coverage or service gaps.
• Design, language, illustrative examples, interactive demonstrations, and other features that are user-tested to ensure that the tool is easy to use and understand.
• Features to enable intermediaries—from family members to brokers to Navigators to the media—to extract or print out information to help consumers who want help.
• Ability to get the user to an excellent plan choice quickly—usually in five minutes or less—with flexibility for users to drill down, if they wish, for increasing detail. CHECKBOOK has found that many consumers will not stick with a tool that requires a half hour or even 15 minutes to reach a good answer—and therefore will make decisions based on misguided criteria, like lowest premium or lowest deductible, when a different plan might actually cost thousands of dollars less and be of higher quality.

About Consumers' CHECKBOOK
Consumers' CHECKBOOK, based in Washington, D.C., publishes ratings of various types of service firms in CHECKBOOK magazine and at checkbook.org in seven major metropolitan areas and produces print and online versions of its Consumers' Guide to Hospitals (including risk-adjusted death rates and adverse outcome rates), its Guide to Top Doctors, and other consumer-information resources. It also does analyses, reports, and surveys under contract for government agencies and other organizations. For example, under a contract with the Centers for Medicare and Medicaid Services, it has managed all of Medicare's surveys of members about Medicare Advantage and Prescription Drug Plans, producing results that are reported in the Plan Finder at Medicare.gov. 

Contact: Jamie Lettis
Consumers' CHECKBOOK
202-454-3006
[email protected]

SOURCE Consumers' CHECKBOOK/Center for the Study of Services