This afternoon at 3:30 EST, I’ll be part of a pre-recorded panel at ARM-2020 where I will be presenting a paper in progress: Association of Insurer Characteristics and Plan Quality Measures in the ACA Health Insurance Marketplaces.
My co-authors, Sih-Ting Cai, Coleman Drake and Jean Abraham, and I, asked a basic question: Does quality ratings vary by insurer characteristics in the ACA individual market?
We looked at four indicators from the CMS Public Use data set and matched on HIOS-ID to the Robert Woods Johnson HIX Compare and Plan Participation data sets. We also matched the HIOS ID to the National Association of Insurance Commissioners data set to get ownership structures. We categorized insurers in four manners:
- Offered a PPO
- Member of the Blue Cross/Blue Shield Association
- Primarily Medicaid Managed Care
The last two are mutually exclusive. The rest are potentially mixed.
We looked at four quality of care indicators:
- Are kids with upper respitory infections treated correctly?
- Are kids with pharyngitis tested correctly?
- Are antibiotics avoided for adults with bronchitis
- Are imagining studies used appropriately for complaints of lower back pain
We had a prior that non-profits and Blues would do better than average, and Medicaid based insurers would do worse.
That is not quite what we found.
Non-profits were a little bit better on two measures. PPOs had lower measured quality on two metrics. Medicaid and Blues had lower quality on one metric.
Why does this matter?
Most people are buying ACA plans primarily on premium and if there is a secondary attribute, it is network. Quality does not matter a whole lot. We think that there is reason to suspect that there is a quality-premium trade-off but there are no easy markers for people to figure out quality on their own. If we want to encourage quality, the ACA price linked subsidy system is likely to be a barrier.