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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

Research conducted by

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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