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Objective Analysis. Effective Solutions.

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.

• 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