December 27, 2012
CMS-9962-NC, Request for Information Regarding Health Care Quality for Exchanges
Value is a very difficult item to calculate. It generally means a fair price in return for goods or services. In health care, the value is determined by the individual. Some individuals may consider the price paid for health insurance fair because it protects them from facing large medical bills if they get sick. Others may not consider health insurance valuable because they are healthy and not worried about getting sick. Therefore, younger people will be less likely to consider their plans valuable. Value will be seen in the amount of services covered by health insurance plans and the out of pocket costs for services or items received.
From a consumer perspective, factors like being able to see a physician in a timely manner, a clear explanation of benefits, timely payment of claims, and/or not having to appeal claims, will be used to calculate value. It is our view that more technical items such as VBP will not make a significant difference, especially in the early years of the Exchanges.
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