Insurance Exchanges Need to Better Support Patient Decision Making

After analyzing the use of HealthCare.gov and 12 state-based exchanges during the first and second open enrollment periods and the data available to consumers before creating an account and after creating an account, researchers from the Perelman School of Medicine at the University of Pennsylvania recommend taking more steps to better support consumers in making informed health plan decisions, according to a letter published in the Annals of Internal Medicine.

The researchers found that while decision tools most likely to be helpful to consumers were more common in the second versus the first period, they still were not universally available.

“Performance of the health insurance marketplaces will significantly depend on such features as the order in which plans are displayed, the plan features listed, and the availability of decision-support tools created for consumers," the study’s lead author Charlene A. Wong, MD, a Robert Wood Johnson Foundation Clinical Scholar and fellow in Penn's Leonard Davis Institute of Health Economics, said in a statement. "While we generally found improvement in the second versus the first open enrollment period, additional measures can and should be added in the future to further improve the selection process for consumers.”

Only 3 states had out-of-pocket cost estimators that added together their premium and expected costs based on consumers’ predicted use while most sites only allowed consumers to sort or filter plans by premium and deductible amounts.

Most states using the premium amount as their default plan order, which may cause consumers’ to be overly influenced by the premium amount while not paying enough attention to other potential out-of-pocket expenses, such as meeting a high deductible, the researchers surmised.

One improvement over the first open enrollment period was that 4 sites had health plan quality rankings in the second open enrollment period compared with just 2 the first year.

“By including more of these tools in both real and ‘window’ shopping stages, marketplaces can help de-mystify what for many is a complex, opaque process,” Dr Wong said.