ESSB 6228 -
By Committee on Health Care & Wellness
ADOPTED AS AMENDED 03/07/2014
Strike everything after the enacting clause and insert the following:
"NEW SECTION. Sec. 1 Consumers face a challenge finding
reliable, consumer friendly information on health care pricing and
quality. Greater transparency of health care prices and quality leads
to engaged, activated consumers. Research indicates that engaged and
educated consumers help control costs and improve quality with lower
costs per patient, lower hospital readmission rates, and the use of
higher quality providers. Washington is a leader in efforts to develop
and publish provider quality information.
Although data is available today, research indicates the existing
information is not user friendly, consumers do not know which measures
are most relevant, and quality ratings are inconsistent or
nonstandardized. It is the intent of the legislature to ensure
consumer tools are available to educate and engage patients in managing
their care and understanding the costs and quality.
NEW SECTION. Sec. 2 A new section is added to chapter 41.05 RCW
to read as follows:
(1) There is created a performance measures committee, the purpose
of which is to identify and recommend standard statewide measures of
health performance to inform public and private health care purchasers
and set benchmarks to track costs and improvements in health outcomes.
(2) Members of the committee must include representation from state
agencies, small and large employers, health plans, patient groups,
consumers, academic experts on health care measurement, hospitals,
physicians, and other providers. The governor shall appoint the
members of the committee, except that a statewide association
representing hospitals may appoint a member representing hospitals and
a statewide association representing physicians may appoint a member
representing physicians. The governor shall ensure that members
represent diverse geographic locations and both rural and urban
communities. The committee must be chaired by the director of the
authority.
(3) The committee shall develop a transparent process for selecting
performance measures, and the process must include opportunities for
public comment.
(4) By January 1, 2015, the committee shall submit the performance
measures to the authority. The measures must include dimensions of:
(a) Prevention and screening;
(b) Effective management of chronic conditions;
(c) Key health outcomes;
(d) Care coordination and patient safety; and
(e) Use of the lowest cost, highest quality care for acute
conditions.
(5) The committee shall develop a measure set that:
(a) Is of manageable size;
(b) Gives preference to nationally reported measures and, where
nationally reported measures may not be appropriate, measures used by
the health benefit exchange and state agencies that purchase health
care;
(c) Focuses on the overall performance of the system, including
outcomes and total cost;
(d) Is aligned with the governor's performance management system
measures and common measure requirements specific to medicaid delivery
systems under RCW 70.320.020 and 43.20A.895;
(e) Considers the needs of different stakeholders and the
populations served; and
(f) Is usable by multiple payers, providers, hospitals, purchasers,
public health, and communities as part of health improvement, care
improvement, provider payment systems, benefit design, and
administrative simplification for providers and hospitals.
(6) State agencies shall use the measure set developed under this
section to inform purchasing decisions and set benchmarks.
(7) The committee shall establish a public process to periodically
evaluate the measure set and make additions or changes to the measure
set as needed.
NEW SECTION. Sec. 3 A new section is added to chapter 48.43 RCW
to read as follows:
(1) Each carrier offering or renewing a health benefit plan on or
after January 1, 2016, must offer member transparency tools with
certain price and quality information to enable the member to make
treatment decisions based on cost, quality, and patient experience.
The transparency tools must aim for best practices and, at a minimum:
(a) Must display cost data for common treatments within the
following categories:
(i) In-patient treatments;
(ii) Outpatient treatments;
(iii) Diagnostic tests; and
(iv) Office visits;
(b) Recognizing integrated health care delivery systems focus on
total cost of care, carrier's operating integrated care delivery
systems may meet the requirement of (a) of this subsection by providing
meaningful consumer data based on the total cost of care. This
subsection applies only to the portion of enrollment a carrier offers
pursuant to chapter 48.46 RCW and as part of an integrated delivery
system, and does not exempt from (a) of this subsection coverage
offered pursuant to chapter 48.21, 48.44, or 48.46 RCW if not part of
an integrated delivery system;
(c) Are encouraged to display the cost for prescription medications
on their member web site or through a link to a third party that
manages the prescription benefits;
(d) Must include a patient review option or method for members to
provide a rating or feedback on their experience with the medical
provider that allows other members to see the patient review, the
feedback must be monitored for appropriateness and validity, and the
site may include independently compiled quality of care ratings of
providers and facilities;
(e) Must allow members to access the estimated cost of the
treatment, or the total cost of care, as set forth in (a) and (b) of
this subsection on a portable electronic device;
(f) Must display options based on the selected search criteria for
members to compare;
(g) Must display the estimated cost of the treatment, or total cost
of the care episode, and the estimated out-of-pocket costs of the
treatment for the member and display the application of personalized
benefits such as deductibles and cost-sharing;
(h) Must display quality information on providers when available;
and
(i) Are encouraged to display alternatives that are more cost-effective when there are alternatives available, such as the use of an
ambulatory surgical center when one is available or medical versus
surgical alternatives as appropriate.
(2) In addition to the required features on cost and quality
information, the member transparency tools must include information to
allow a provider and hospital search of in-network providers and
hospitals with provider information including specialists, distance
from patient, the provider's contact information, the provider's
education, board certification and other credentials, where to find
information on malpractice history and disciplinary actions, affiliated
hospitals and other providers in a clinic, and directions to provider
offices and hospitals.
(3) Each carrier offering or renewing a health benefit plan on or
after January 1, 2016, must provide information regarding cost and
quality performance. The information must:
(a) Be prominently displayed on the carrier's web site alongside
other consumer tools; and
(b) Include performance information from the following cost and
quality performance measurement programs or indicate that the carrier
does not participate in the program:
(i) The national business coalition on health performance measures,
with scores and comparisons with national and regional benchmarks;
(ii) The national committee for quality assurance quality compass,
with Washington state rankings for the prior three years;
(iii) National committee for quality assurance accreditation, with
the report card on plan type, overall accreditation status, and star
rating; and
(iv) The carrier's medicare five-star rating if the carrier
participates in medicare advantage.
(4) The insurance commissioner must prepare a brief, standardized
statement for each cost and quality program described in subsection (3)
of this section to explain how consumers may use the information to
make cost and quality comparisons. The statement must be displayed
with the information required by subsection (3) of this section.
(5) Each carrier offering or renewing a health benefit plan on or
after January 1, 2016, must, within thirty days from the offer or
renewal date, attest to the office of the insurance commissioner that
the member transparency tools meet the requirements in this section and
access to the tools is available on the home page within the health
plan's secured member web site."
Correct the title.
EFFECT: (1) Establishes a performance measures committee to
identify and recommend standard statewide measures of health
performance. Provides that the committee is chaired by the Director of
the Health Care Authority (HCA). Directs the Governor and statewide
associations representing hospitals and physicians to appoint members
to the committee. Requires that committee members represent diverse
geographic locations and rural and urban communities, as well as state
agencies, small and large employers, health plans, patient groups,
consumers, academic experts, hospitals, physicians, and other
providers.
(2) Requires the committee to develop a transparent process to
select performance measures, including an opportunity for public
comment. Requires the committee to submit measures to the HCA by
January 1, 2015. Specifies what the measures must include (e.g.,
dimensions of prevention and key health outcomes).
(3) Requires the committee to develop a measure set that: (a) Is
of a manageable size; (b) gives preference to nationally reported
measures and, when those may not be appropriate, measures used by the
Health Benefit Exchange and state agencies; (c) focuses on overall
performance of the system; (d) is aligned with the Governor's
performance management system measures and common measure requirements
specific to Medicaid delivery systems; (e) considers needs of different
stakeholders and populations; and (f) is usable by multiple payers,
providers, purchasers, and communities.
(4) Requires the committee to establish a public process to
periodically evaluate and make additions or changes to the measure set.
(5) Requires state agencies to use the measure set to inform
purchasing decisions and set benchmarks.
(6) Requires carriers to display cost data for diagnostic tests
(rather than diagnostic treatments). Maintains the requirement that
transparency tools be accessible on a portable electronic device, but
deletes the requirement that they be accessible while sitting in the
doctor's office. Requires the tools to: Allow hospital searches of
in-network hospitals; include where to find information on malpractice
history and disciplinary actions (rather than the malpractice history
and disciplinary actions themselves); and provide directions to
provider officers and hospitals (rather than provide maps and driving
directions).
(7) Requires carriers that offer or renew a health benefit plan on
or after January 1, 2016, to prominently display information on cost
and quality performance on the carrier's web site alongside other
consumer tools. Requires the carrier to include performance
information for the following programs or indicate the carrier does not
participate in the program: The National Business Coalition on Health
performance measures, with scores and comparisons with national and
regional benchmarks; the National Committee for Quality Assurance
quality compass and accreditation, with Washington rankings for the
prior three years, report card on plan type, overall accreditation
status, and star rating; and the carrier's Medicare five-star rating if
the carrier participates in Medicare Advantage. Requires the Insurance
Commissioner to prepare a brief statement for each of these programs to
explain to consumers how to use the information to make comparisons,
and requires the statement to be displayed with the cost and quality
performance information.
(8) Removes the restriction on rulemaking by the Office of the
Insurance Commissioner.