Open Enrollment Data
In an effort to increase transparency, HHS anticipate “publicly releasing the Exchanges annual State-based Marketplace Annual Reporting Tools (SMARTs), programmatic and financial audits, Blueprint applications, and additional data points in the Open Enrollment (OE) Data Reports.”[29] They anticipate beginning with the plan year 2023 SMART.
HHS also anticipate expanding Open Enrollment data by publishing additional metrics related to State Exchange operations and functionality. This information is already collected and does not reflect additional reporting. It includes: State Exchange spending on outreach (including Navigators), eligibility and enrollment policies and processes, plan certification requirements, and operational performance data, including Open Enrollment call center metrics (call center volume, average wait time, average call abandonment rate) and website visits and visitors.
Quality Improvement Strategy Data
A quality improvement strategy (QIS) is required for each QHP issuer intending to participate on the exchange. QIS is defined as a “payment structure that provides increased reimbursement or other incentives for improving health outcomes of plan enrollees, and the implementation of activities to prevent hospital readmissions, improve patient safety and reduce medical errors, promote wellness and health, and reduce health and health care disparities.” [30]
HHS is proposing to make aggregated, summary-level QIS information publicly available.[31] This would be done annually, beginning on January 1, 2026 with information from 2025.
The data expected to be made available includes:
(1) value-based payment models used in QHPs offered by the issuer;
(2) QIS topic area;
(3) QIS market-based incentive types;
(4) clinical areas addressed by QIS;
(5) QIS activities; and
(6) QRS measures used in QIS
[29] C. Part 155—Exchange Establishment Standards and Other Related Standards – 9. General Program Integrity and Oversight Requirements (§155.1200)
[30] D. Part 156—Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges – 9. Quality Improvement Strategy (§156.1130)
[31] 9. Quality Improvement Strategy (§156.1130)