Minnesota’s Plans for Helping Consumers Choose a Health Plan in the Exchange

Buying health insurance on the individual market can be an exercise in frustration.  There is the risk of information overload, with a dizzying array of details to process around plan premiums, cost-sharing, out-of-pocket limits, benefit design, and more. There is also the possibility that key information will be unavailable, particularly around provider networks.  Ultimately, this means that it’s easy for a consumer to choose a plan that does not meet his or her needs.  Poor coverage decisions may result in increased costs, inadequate coverage, and the disruption of existing provider relationships—outcomes that policymakers are keen to minimize.
So what’s a health insurance exchange to do?  Books like Nudge tell us that the way choices are organized can make a world of difference in consumer decisions.  Accordingly, Consumers Union, the policy and advocacy arm of Consumer Reports, commissioned a report entitled “Choice Architecture: Design Decisions that Affect Consumers’ Health Plan Choices.”  The report discussesconsiderations for state health insurance exchanges as they seek to guide consumers to plans that fit their needs and preferences.
I sat in on a discussion between Katie Burns of the Minnesota Department of Commerce’sexchange team and Lynn Quincy of Consumers Union about Minnesota’s thinking about choice architecture so far.  Read these highlights from their conversation, and share your state’s approach in the comment section below.
Lynn: Where is Minnesota in developing a user interface for the exchange?
Katie: We’re at the beginning stages—there are a lot of decision points that are to come.  We signed a $41 million exchange IT development contract in July that will cover a range of activities to build the exchange (see pages 23-26 for relevant information).  The provisions of the contract require the vendor to develop choice architecture so that consumers can more readily find plans that meet their needs. The vendor will have to develop mechanisms for consumers to search for plans by cost, quality, and whether a plan covers a particular health care provider.  We expect the sophistication of our choice architecture will grow over time as we move past exchange version 1.0, into versions 2.0 and 3.0.
Lynn: How will you gather information on plans’ provider networks?
Katie: We’ll be putting together an all-plan consolidated provider directory as part of this IT build.  We recognize that this is a fundamental piece of the equation for consumers—it’s very likely that consumers will want to know whether their doctor is in the network for a given plan.  We also plan to integrate clinic and hospital quality data as well as composite cost and quality metrics that the state has developed through other health reform initiatives.
Lynn: What will the initial display look like when a consumer searches for health insurance on your exchange?
Katie: We still have to work this out and we’ll be consulting with stakeholders as we design how to display plan information.  There’s a natural tension between ensuring a simple shopping experience and showing all choices. We think consumers should be able to choose to view all the plan options, or they should be able to answer a few questions on their specific needs and be presented with the plans that are the best fit for them. Our sense is that by limiting the number of plans presented, consumers will avoid cognitive overload, so that may be the best option to use as the default.
Lynn: Will carriers in Minnesota be able to offer any number of plan options through the exchange?  Experience from Massachusetts, Medicare Advantage, and Medicare Part Dsuggests that there is limited benefit to consumers when carriers can offer multiple plans that are only marginally different.  Too many options can be tricky for consumers.
Katie: This is a topic of robust conversation here in Minnesota. Some stakeholders would like to see a full range of choices, others would like to see some limitations, and others are recommending that we require some meaningful differentiation between plans offered by the same carrier.  We have yet to make a final decision.
Lynn: Do you have any plans for consumer testing the exchange user interface?
Katie: Our IT development contract includes a requirement for consumer testing on the display of information about health plan choices.  The vendor will develop a testing plan and submit it to us for approval. A panel of testers or focus groups will be recruited that is reflective of the population that we expect will use the exchange.  We plan to test options for default views with this group. Once we launch the exchange, we will analyze how consumers use information to make comparisons and selections, including through surveys.  We’ll learn from that, and then make adjustments.
Lynn: How will consumer satisfaction ratings or plan reviews fit in?
Katie: We’re considering using CAHPS as the basis of our satisfaction report, since it’s important to us that the tool we use is validated and well-tested.  Integrating this data into the plan choice menu will evolve over time as we can more directly measure experience with plans offered on the exchange.  Regarding consumer reviews: I think there are other venues out there for this kind of Amazon.com-like functionality.  But the exchange probably isn’t the right place for people to vent about coverage denials, cost-sharing, or other potential frustrations.
Lynn: The measured, careful approach you are taking fills me with confidence that you are building a great site.  Thanks for speaking with me today.
How are decision makers in your state approaching the issue of choice architecture in the exchange? Tell us in a comment below.