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Understanding the Newly- Required Quality Ratings System



Beginning this OEP, keep a lookout for a new feature that is now required to be displayed with every Qualified Health Plan, the Quality Rating System (QRS). Read more below for the important details regarding these ratings.


What are QSR Star Ratings

Beginning for the 2022 OEP, all Federal and State-Based Exchanges and EDE entities must publicly report the QSR information for all plans.

This newly required feature is meant to assist consumers in comparing plans and determining which plan best fits their needs. These plans will have a 1-5 overall star ratings (1 being the lowest, 5 the highest), as well as 3 sub-ratings. The sub-ratings will include:


  1. "Medical Care"- The quality of care provided by this plan's network providers, including providing regular screenings, vaccines, monitoring conditions, and other basic health services.

  2. "Member Experience"- This measures how satisfied members are with their overall healthcare, physicians, and ability to schedule appointments and services.

  3. "Plan Administration"- Overall, how efficiently is the plan run. This includes customer service, access to needed information, and network doctors ordering appropriate treatments and tests.


How are the QRS Star Ratings Determined

Each plan's QSR rating is sourced from QHP Enrollee Surveys, distributed by all carriers with 500+ members and submitted to CMS between May and June each year.

The surveys contain a set of questions developed by CMS to determine the opinions of enrollees on the services provided by their Qualified Health Plan. The survey questions are based around the three sub-ratings listed above, with "Medical Care" getting more weight in the overall rating than the other two.

There are two exceptions when it comes to the required star ratings:

  1. "New plan - Not rated" is when the QHP is ineligible because it has not been in operation for at least three consecutive years.

  2. "Not rated" is given when the plan did not meet other eligibility requirements, such as not meeting the participation criteria.

The QRS star ratings come directly from the QHP Enrollee Survey results and are not influenced by any government or private entities.


QSR Ratings and Your Client

While QSR ratings help simplify the plan selection process for you and your client, it is important not to let your client get too focused on the star ratings alone. Here are a few key points to make to your client regarding the star ratings:

  • Start by focusing on plans that best fit the medical needs of the client, in relation to their provider, prescriptions, and services

  • Though helpful, QSR ratings are based on enrollee experiences from the previous year, so carriers with low ratings the previous year very well may have more motivation to improve their plan services

  • You are still their agent and available year-round to provide insight into the quality of available plans, don't leave your clients to rely entirely on the QSR ratings when selecting a plan.

For those agents using Healthsherpa, you will find the QSR Star ratings on three different pages.

  1. The first will be on the plan list, where they will appear in the top right of each plan box.

  2. The second page containing the QSR Rating is plan details, where the ratings will be broken down into the sub-ratings as well.

  3. The third is on the compare plans page.

Overall the QSR Star ratings are a very useful addition to the Exchange and EDE platforms and will greatly assist your clients in deciding which plan to enroll in. Just remember that as the agent, you are also an intricate part of this decision-making process and to use the QSR Ratings as a supplement and not a replacement in the process of selecting a plan for your clients.


 

If you have any questions about these updates, you can find support by calling the Keystone Agent support line at (346) -233-1992.


If you aren't yet an agent with Keystone Advisors, you can complete an onboarding form at keystoneadvisorsproduceracademy.com/partnerwithkeystoneadvisors

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