The ACA envisions another role for Exchanges: driving improvements in the quality of care delivery and generating cost savings for consumers and businesses. The ACA includes a number of provisions to achieve this goal.
To encourage quality improvement, insurers must report on how they are improving health outcomes, reducing hospital readmissions, implementing patient safety and error reduction programs, promoting prevention and wellness, and reducing health disparities to HHS enrollees. HHS will post these reports on the web portal, www.healthcare.gov. To provide coverage in the Exchanges, health plans must be accredited by an entity such as the National Committee for Quality Assurance (NCQA), which assesses health plans based on quality performance and patient experience. Other requirements for health plans include: developing provider payment strategies to improve quality and patient safety, requiring hospitals to implement patient safety systems and use discharge planning for patients, and including in their networks only those doctors and providers who implement certain quality improvement mechanisms.
The law also encourages Exchanges to limit insurance premium increases, by allowing the Exchanges to exclude health plans that have a history of unreasonable premium increases. States can also design Exchanges that actively negotiate premium discounts with health plans on behalf of enrollees. Finally, Exchanges are required to rate health plans based on quality and price.