Yet, while CMS won’t require QHPs to submit this data for another year, beta testing will being in 2015, meaning health plans have only a few short weeks to prepare.

This program will closely resemble the Medicare Advantage (MA) Five-Star Quality Rating System, which rates MA plans based on their performance in a number of key measures. Similarly, through the QRS, all QHPs in the exchanges will be subject to such measures as access to care, access to information, plan administration and overall rating of the health plan.

This may come as a shock to commercial health plans, as many have not dealt with the challenges that MA plans have faced in achieving acceptable ratings in the similar Five-Star system.

Yet, success in the QRS program is vital to plans’ success in the exchanges.

During the 2016 exchange enrollment period, health plan ratings will appear on exchanges for all to see. Poor performance in any of these areas could be potentially damaging to a carrier’s enrollment numbers or ability to offer coverage.

Insurers must get their ducks in a row now, especially if they plan to have any level of success during the 2015 beta test.

To properly prepare, plans must:

• Understand key measures as it pertains to their business
• Identify which areas of patient care and/or satisfaction influence these measures
• Determine a game plan for collecting and monitoring data
• Proactively address any issues that may arise

Doing so will ensure that plans are proactively addressing any issues that may affect their quality ratings in 2016, and in turn, enrollment numbers.

If you are unsure of how to address these changes, contact Cody Consulting today.

Driving the Shift

As of mid-June, 8 million Americans have enrolled for health coverage in the health insurance marketplace (also known as the “exchanges”), a program born of the ACA. Some of those 8 million people did not previously have health coverage at all; others had previously been covered by their employers but sought coverage through the exchanges when they lost their company-sponsored health insurance. Where did their employer-sponsored coverage go?

Many companies – including behemoths Walmart, McDonald’s and Starbuck – are laying off employees or reducing their hours in order to avoid the directive to buy insurance or pay the fine for failing to do so. In fact, a Congressional Budget Office (CBO) report issued in February estimated that by 2017, the American workforce will be reduced by the equivalent of 2 million full-time jobs, because of the ACA. To take this a step further, prominent bioethicist Dr. Ezekiel Emanuel recently predicted most employers will discontinue providing health coverage entirely by 2025.

In addition, some people are voluntarily leaving their jobs, now that affordable health coverage is available. This is particularly true for older employees who are not yet eligible for Medicare. No longer do these individuals need to continue working solely to retain their company-sponsored health insurance, because enrolling in the exchanges does not require a health screening nor does it exclude for pre-existing conditions. In fact, with the ability to enroll in the exchanges, a person of any age is now no longer tied to their employer to keep their health coverage – creating a fundamental shift in how healthcare is provided in our country.

Pros and Cons of a Portable Workforce

Americans who enroll in the exchanges can take their health insurance with them wherever they go, whether it’s to a different company, into retirement, or being self-employed. A portable workforce that doesn’t have to rely on an employer for health coverage creates an independence that promotes self-employment, creation of start-ups and a capitalist society with greater innovation.

However, individuals enrolled in the exchanges cannot deduct their health insurance premiums from their annual tax returns. And while companies that provide group health insurance can deduct those premiums, employers who avoid paying for group health insurance by pushing employees to the exchanges will face a mandate to pay a penalty with after-tax dollars. This can be seen in the recent IRS ruling that bars employers from pushing workers into exchanges, which the The New York Times covered in an article on May 25. We predict that once the exchanges become more fully developed, future legislation will be introduced to allow employers of all sizes to move employees freely into the exchanges without penalty.

As the demand for coverage through the state exchanges increase, the ACA’s health insurance marketplace will improve its products and options. And as more people enroll in the exchanges and no longer rely on their employers for health coverage, America will see a more portable and innovative workforce take shape.