Final Report: Evaluation of Tools and Metrics to Support Employer Selection of Health Plans
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The Patient Protection and Affordable Care Act (ACA) places strong emphasis on quality of care as a means to improve outcomes for Americans and promote the financial sustainability of our health care system. Included in the ACA are new disclosure requirements that require health plans to provide a summary of benefits and coverage that accurately describes the benefits under the plan or coverage. These requirements are intended to support employers' procurement of high-value health coverage for their employees. This report attempts to help employers understand the structural differences between health plans and the performance dimensions along which plans can differ, as well as to educate employers about available tools that can be used to evaluate plan options. The report also discusses the extent to which these and other tools or resources are used by employers to inform choices between health plans.
Table of Contents
Chapter One
Introduction
Chapter Two
Technical Approach
Chapter Three
Conceptual Framework
Chapter Four
Provider-Facing Structural Characteristics of Health Plans
Chapter Five
Member-Facing Structural Characteristics of Health Plans
Chapter Six
Process Measures
Chapter Seven
Outcomes Measures
Chapter Eight
State of Practice in Employer Decisionmaking About Health Plans
Chapter Nine
Conclusions
Appendix A
Description of Summary of Benefits and Coverage and Glossary of Terms
Appendix B
Description of Search Strategies and Tools
Appendix C
Descriptions of Quality Measurement and Reporting Organizations
Appendix D
Descriptions of Quality Measurement and Reporting Organizations
The research described in this report was sponsored by the U.S. Department of Labor, and was produced within RAND Health, a division of the RAND Corporation.
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