Plan, how to guarantee assistance to consumers within the Exchange, etc. will have a direct impact on each and every New Yorker who currently receives or will receive health insurance benefits through a qualified health plan under the Exchange beginning in 2014. It is also true that tens of thousands of New Yorkers with multiple and complex chronic conditions may have special needs when it comes to their ability to interpret quality ratings of participating Health Plans. For this reason and because we have prior experience as providers dealing with some of the issues that impact consumers of our services as they deal with their insurers, during the interim Exchange period (2014-2016) New York State must re-double its’ efforts to conduct adequate surveillance and compile accurate and timely information regarding the performance of health plans participating in the Exchange, and to communicate this information in a manner that makes sense to individuals with cognitive and other challenges. We do not think it advisable for NYS to defer to existing measures of quality and satisfaction over the next two years without first taking a hard look at: 1) the resources the state currently devotes to the collection of this information and the reporting mechanisms in place to gather it from participating health plans and customers; and, 2) how we meet the needs of health insurance consumers in terms of spreading the word regarding their rights and responsibilities and particularly as the information relates to – behavioral health services. In short, we feel strongly we must take the time to agree upon how we are going to define and / or operationalize the terms “quality” and as they relate to Qualified Health Plans between “satisfaction” 2014-2016. This is not an issue or an exercise that should be postponed. It is precisely because the initial results of the Exchange experiment between 2014 -2016 are so important to the long-term functioning and success of the Exchange that we feel it is essential to take a step back and look at how NYS currently defines quality and satisfaction, and how we go about collecting the information to come up with ratings for plans. The one thing we are sure of as behavioral health providers is that current attempts by the state to monitor plan behavior
Plan, how to guarantee assistance to consumers within the Exchange, etc. will have a direct impact on each and every New Yorker who currently receives or will receive health insurance benefits through a qualified health plan under the Exchange beginning in 2014. It is also true that tens of thousands of New Yorkers with multiple and complex chronic conditions may have special needs when it comes to their ability to interpret quality ratings of participating Health Plans. For this reason and because we have prior experience as providers dealing with some of the issues that impact consumers of our services as they deal with their insurers, during the interim Exchange period (2014-2016) New York State must re-double its’ efforts to conduct adequate surveillance and compile accurate and timely information regarding the performance of health plans participating in the Exchange, and to communicate this information in a manner that makes sense to individuals with cognitive and other challenges. We do not think it advisable for NYS to defer to existing measures of quality and satisfaction over the next two years without first taking a hard look at: 1) the resources the state currently devotes to the collection of this information and the reporting mechanisms in place to gather it from participating health plans and customers; and, 2) how we meet the needs of health insurance consumers in terms of spreading the word regarding their rights and responsibilities – and particularly as the information relates to behavioral health services. In short, we feel strongly we must take the time to agree upon how we are going to define and / or operationalize the terms “quality” and “satisfaction” as they relate to Qualified Health Plans between 2014-2016. This is not an issue or an exercise that should be postponed. It is precisely because the initial results of the Exchange experiment between 2014 -2016 are so important to the long-term functioning and success of the Exchange that we feel it is essential to take a step back and look at how NYS currently defines quality and satisfaction, and how we go about collecting the information to come up with ratings for plans. The one thing we are sure of as behavioral health providers is that current attempts by the state to monitor plan behavior
QHP-Customer-Satisfaction-Ratings.docx