California Health Exchange Puts Pressure on Health Plans and Providers to Perform

by John Hansen

Already, the Covered California Health Exchange is requiring all carriers (even Blue Cross/Blue Shield PPO’s) to assign all members a Primary Care Physician (PCP). They want everyone to have a doctor, and they want everyone to be getting their checkups and preventative tests.

The California Health Exchange to Evaluate Hospitals, Clinics and Doctors

Evaluations will be done on doctors and hospitals to see how well they’re doing related to various health care outcomes. These results will be published, and will likely influence consumer choice regarding selection of health insurance coverage.

Peter Lee of Covered California even mentioned the possibility of kicking health plans out of the California Health Exchange based on this data. As an example, he mentioned the possibility of Obama Care California not contracting with providers who have higher rates of C-sections.

Goal: Quality of Care for California Consumers

Covered California is on the warpath for quality of care. They are expected to be testing hospital quality, admission rates, infectious disease rates and more. Quality ratings are going to become more transparent. Likely, in the near future, we will be able to see data online related to the evaluations of hospitals, clinics and even individual doctors.

Health plans and providers who fail to do well can expect pressure from the California Health Exchange, or they can expect to be removed from the California Health Insurance Marketplace altogether.