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HealthCare Checkup

The Seattle Times health-care team tracks the local impact of the Affordable Care Act.

August 21, 2014 at 7:38 PM

Healthplanfinder: ‘Moderately effective,’ could improve

How does Washington’s online exchange marketplace compare with those in other states?

As part of an ongoing study, the nonprofit Urban Institute assessed how well state exchanges created  under the Affordable Care Act provide the sort of information consumers want to know about insurance plans they’re considering buying.

The report — Physician Network Transparency: How Easy Is It for Consumers to Know What They Are Buying? — gives Washington’s creditable marks. At the same time, the report notes room for improvement.

The report judged Washington’s site to be in the “moderately effective” group, which also included Colorado and Oregon. On the lower end of the transparency scale were the District of Columbia and Rhode Island. Top scorers were California,, Massachusetts and Minnesota.

Washington’s is one of only two sites allowing consumers to search for plans based on their type — HMO or PPO. (Washington’s site lists the plan type clearly under each listing.) But the report noted that because definitions are not on the browsing page itself, the consumer must drill down into the plan details to learn more.

The report also gives Washington credit for being one of only three states to offer a searchable physician directory as part of its plan browsing.  “In Washington, a consumer can search for a provider within a 20-mile radius of their Zip code. Once selected, the search results clearly display whether the selected provider is included in the network for each plan,” notes the report.

At the same time, the Urban Institute found several significant limitations to the directory.

“One notable limitation of this system is that the consumer is unable to select multiple providers simultaneously, and instead must search for a single provider at a time. Additionally, there is no embedded functionality to search for a physician by specialty without knowing his or her name. It is possible to search for all physicians within a given area, but these results are displayed alphabetically, and there is no capability to filter by specialty, whether the physician is accepting new patients, or other criteria. These search results are unwieldy for consumers who do not have a usual source of care and wish to browse available options.”

At its last meeting, the board of the Washington Health Benefit Exchange considered several transparency tools suggested by the Healthy Washington Coalition, comprising more than a dozen advocacy organizations and unions.

Consumers, the coalition said in a letter to the board, “lack the tools they need to select the best plan for them.” The coalition suggested these items, which it said are “sorely missing” from the website’s current iteration:

  • An improved provider directory that lets consumers search by clinic, not just doctor.
  • A “Drug Finder” tool that would let them know which plans cover their needed medications.
  • A Total Cost Calculator that would lay out total out-of-pocket costs.
  • A voluntary pregnancy-termination coverage comparison. Plan language on coverage, the coalition said, is “inconsistent at best or unavailable at worst.”

But in the exchange board’s Aug. 14 meeting, Robert Nakahara, the exchange’s chief financial officer, calculated that the IT costs for the first three items would run between $3.5 and $4 million, including annual maintenance costs.

Several board members expressed concern about the size of the budget, noting that the Legislature holds the purse strings even for funds generated by the exchange itself, such as the portion of premium taxes collected on plans sold on the exchange. “We have almost a candy store mentality, adding stuff and adding stuff,” said board member Don Conant.

A bare-bones budget — without such transparency tools — would be about $53 million, the exchange staff calculated. But so far, although there are other possible sources of revenue still in play,  lawmakers have allocated only $40 million to be disbursed to the exchange.

“Our biggest risk is going there and having [legislators] say ‘$40 million,’ ” said board member Bill Hinkle, a former legislator. “If you think that’s not a real probability, then you’re not reading the tea leaves.”

Insurance Commissioner Mike Kreidler, an ex officio member of the board, said while some may look at such enhancements as frivolous, the push toward transparency is where the exchange has to be heading.

“I think we really have an obligation to really take a look at what kind of transparency issues are going to be critical to the long-term success of the exchange,” Kreidler said.

At its Aug. 28 meeting, the board plans to sign off on a requested budget for consideration by Gov. Jay Inslee and the Legislature.

Comments | Topics: Affordable Care Act, Bill Hinkle, Don Conant


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