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Allowing 'Ultra Lite' Exchanges Will Blow Big Chance to Improve Care, Kaiser Exec Warns

By John Reichard, CQ HealthBeat Editor

October 13, 2010 -- If the Department of Health and Human Services decides to let states set up minimal health insurance exchanges under the health care overhaul, a big opportunity to improve the nation's quality of care will be squandered, the chief executive of the nation's largest nonprofit health plan warned Wednesday.

"There are people who want to make the exchanges 'ultra lite;' they want to make the exchanges data narrow; they want to make the exchanges data free," the executive, George Halvorson of 8.6 million-member Kaiser Permanente, told a forum sponsored by the National Committee for Quality Assurance (NCQA).

"I would ask everyone in this room, if you're influencing anybody who is influencing the development [of] designs for the exchanges, please push it in the direction toward having smart exchanges, not dumb exchanges," he said.

Halvorson said quality performance data developed by NCQA, called "HEDIS measures," has evolved to the point where health care purchasers have used it to drive big improvements in the quality of care. Employers have used the measures to obtain baseline data on the quality of care in hundreds of health plans and to push for improved performance on those measures.

For example, HEDIS, which stands for Healthcare Effectiveness Data and Information Set, measures the extent to which health plan enrollees who suffer heart attacks are treated with beta blocker drugs, a proven lifesaving practice that prevents repeat heart attacks.

But through the creation of exchanges, individual consumers, not just employers, also will be able to use such data to pick higher-quality health systems, he says. "If exchanges are done well, it will give consumers a magnificent set of data that can be used to make meaningful choices," he said.

"The likelihood of dying of cancer doubles over five years if you make the wrong choice of care site," Halvorson said. He said that the chance of dying from coronary bypass surgeries goes up by almost a factor of ten "if you have the surgery done at one site than if you do it at another."

Halvorson said after his remarks that he was referring to the exchange operating in Utah when he talked about "ultra lite" exchanges. Utah "says they are going to put some basic information" about premiums and benefits in the exchange, Halvorson said. "I can see why for administrative reasons they may want to do that. But I think it's a lost opportunity. And I think what they should do is wait a little while until somebody else builds a template" for quality data reporting Utah could follow, Halvorson said.

Robert Spendlove, an adviser to Utah Gov. Gary R. Herbert, said in an interview that financially strapped states like Utah just aren't in a position to operate the big insurance exchanges he fears HHS will insist on under the law.

In response to Halvorson's comments, Spendlove said "I completely agree that cost and quality data is essential for an informed consumer." Utah is developing an "all-payer" database that includes information on quality of care from various types of plans in the state, he said, but that effort "is a work in progress" and the data isn't yet part of the state's exchange.

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