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Are Health Insurance Companies Ranking Themselves On Cover Oregon?

OPB | Oct. 24, 2013 4:14 p.m. | Updated: Jan. 3, 2014 2:18 p.m. | Portland

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The ads for Oregon’s new health exchange, Cover Oregon, invited people to visit the new health exchange.

So Portland entrepreneur, Justin Epperly, thought he’d check it out.

He designs web pages for businesses like food carts.

Portland entreprenuer Justin Epperly is troubled that the organization that ranks insurance companies for Cover Oregon, recieves money from insurance companies and has insurance company representatives on its board.

Portland entreprenuer Justin Epperly is troubled that the organization that ranks insurance companies for Cover Oregon, recieves money from insurance companies and has insurance company representatives on its board.

Kristian Foden-Vencil / OPB

“I’m an employer, bam. Here’s learn more, browse plans, contact. Okay, let’s browse plans, bam. Let’s say, you and me are business partners and we’re going to pick. Alright we want the best for our employees, we want platinum…. So all of these are platinum but one is three and a half stars and one is three stars. There’s got to be criteria that makes it this many stars so let’s click. And see it doesn’t. And what it is is just an image of stars.”

So the question is, why does one get four stars, one get two stars and one gets three stars?

A representative from Cover Oregon responded to questions about the ranking in an e-mail, saying the exchange is working to put more ranking information on the website.

For questions on how the ranking was put together, Cover Oregon referred OPB to the ‘Oregon Health Care Quality Corporation.’

Q-Corp, as it’s known, bills itself as an independent nonprofit that produces unbiased information.

It’s funded by several sources including the Robert Wood Johnson Foundation, the Oregon Health Authority and Cover Oregon. But it also gets about a third of its income from health insurance companies. They give Q-Corp their administrative claims data and Q-Corp digs through it looking for better and cheaper ways to deliver health care.
Epperly thinks that’s a conflict of interest.

“The people that are rating the insurance company quality, are the insurance companies,” he said. “Because the board and everybody involved with this is a health care industry professional.”

Q-Corp’s 22-member board has about a half-dozen members who are with insurance companies. The other positions include doctors, hospital administrators, government agencies, advocates for people with certain diseases, consumers and other health care experts.

Q-Corp’s executive director, Mylia Christensen says insurance companies don’t have undue influence on the star system, and all stakeholders need to be involved in decisions.

“The complexity of this work is really difficult to communicate,” she said.

For example take just one aspect of the star ranking, she said — breast cancer screening.

Q-Corp has to dig through claims data from each insurance company to see whether their customers are getting the recommended number of mammograms at the recommended ages.

The same job has to be done for flu shots, well-child visits, diabetes screenings and several other measures.
All that data is then compiled into a ranking. The findings can then be compared.

Christensen says it’s not a job that can simply be handed over to an organization unfamiliar with health care.

“There are a tremendous amount of moving parts that are happening,” she said. “The health insurance exchange is happening, at the same time that the coordinated care organizations are launching, at the same time that private and commercial plans are also launching. There are a lot of moving pieces and one of the benefits of having an organization like Quality Corp is that we can take a look at what’s happening all across. So how is this activity that’s happening on the Medicaid side actually impacting what’s happening for those individuals insured on the commercial side.”

Epperly understands the complexity. But he’s not convinced, “I can’t help but think that they’re trying to hide something,” he said.

And at least one insurer questions the system, Oregon’s Health Co-Op.

It’s starting to sell insurance on the exchange, and though it’s a new company, already has a ranking.

“We’re really venturing into completely uncharted territory,” said Oregon’ Health Co-Op CEO Ralph Prows.

“And I’ve raised concerns about that with Cover Oregon and they have agreed to review the methodology with me. With these issues in mind, we are all on an adventure together.”

Prows also happens to sit on Q-Corps board of directors.

So bottom line: Does having insurance companies involved in ranking themselves at Q-Crop give them undue influence?

“I think it makes sense to ask the question. I don’t think that there’s reason to be concerned,” said Jesse O’Brien  with the consumer group OSPIRG. He digs through the same claims data and uses it to battle insurance companies at rate hike hearings.

“There’s good reason to think that this is good data, good quality data that’s independent of the interests of the insurance companies.”

O’Brien says it’s worth noting that many of the new state health exchanges don’t rank their insurance companies — leaving consumers to base their decision on gut instinct instead.

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