A ‘smart’ Health Insurance Exchange would structure a competitive insurance market that drives care delivery innovation toward improved performance and lower cost growth by incorporating, at a minimum, these three principles of ‘smart’ Exchange design:
1. Robust insurance plan competition
The insurance market created by the Exchange can only produce optimum outcomes if qualified insurance plans compete vigorously for consumers’ dollars based on cost and quality of the care delivery options they offer.
2. Informed consumers
The Exchange will succeed only if consumers are able to understand their options in clear, honest and straightforward language — and then compare those options based on quality and cost. A successful state Exchange will provide consumers convenient access to accurate, meaningful and easily comparable information on cost and quality that enables them to make informed choices.
3. Team-based care
The importance of team-based care coordination for improving health outcomes and lowering growth in costs is well-established. The ‘smart’ Exchange harnesses insurance plan competition to drive continuous improvement in performance of team-based care. It does this by setting an ambitious but achievable timetable for each participating health plan to offer all of its Exchange beneficiaries the choice of at least one team-based care delivery option.