News/Commentary

Whatever happens on the debate about health care reform, Senator Jay Rockefeller has proposed a practical idea which would create more transparency between health plans and their members.

Rockefeller proposes a non-profit organization to grade health plans in the following ways:

• Adequacy of coverage.
• Affordability of coverage.
  
• Customer satisfaction.
• Provider satisfaction.
• Transparency of procedures and decision-making.

Transparency is a fancy name for doing business straight. Everybody knows what is supposed to happen and how. Bartering is a perfect example of transparency. Someone wants one service. Another person is willing to trade goods or other services in exchange to get that one service. They agree on their terms. When bartering works as intended, both parties get exactly what they agreed upon.

When a contract, a much more sophisticated form of exchanging goods and services, involves many millions of people plus assorted buyers and sellers—-many of whom do not understand the service that they need—-transparency is hard to come by.

Health care coverage is one of those kinds of contracts, with so many layers of administration and so many kinds of buyers and sellers, maybe no one has the whole picture.

No matter how health care is paid for in America, there is anxiety across this nation about what coverage people can really count on.

Assuming a non-profit organization for this purpose is set up and managed effectively, the data which comes out of it should lead to a better understanding of plans’ performance.

The measurement system would have to be developed, tested and fine-tuned before it should be used as a standard of performance measurement. This will be powerful data. This data would have to be collected and analyzed to meet the highest standards for evidence which exist. Plans should have access to information about grading methods and standards before they are applied.

Plans would be graded consistently, which should enable patients to make better purchasing decisions at health plan  enrollment time, assuming that they have more than one plan available to them.

As health plans use roughly the same kind of methodology to identify doctors and hospitals which they want in their networks, this should be familiar ground for the insurers and, so, easier for plans to deal with administratively.

New York Times Editorial Page

…“ And clear evaluations of both public and private plans would be a boon for consumers. Senator Jay Rockefeller has proposed creating a nonprofit organization to grade all plans offered on a national exchange based on such factors as adequacy of coverage, affordability, customer and health provider satisfaction, and transparency of procedures and decision-making. (Emphasis added)

“The health insurance industry has pledged to assist in the reform effort. Congress will have to be tough and vigilant to ensure that it does.”

Source: New York Times, June 29, 2009