By Julie Silas, Consumers Union

Over the past two years, like many of you, I have been expending my energy on fine tuning important policy positions that will impact millions of people (hello, please, no more proposed regulations!).  While I have tried to wade into the practical, concrete functionality that will be essential for those same millions of people to select a health plan, policy makers have not released much detail about how people will use exchange websites to find the right health plan for themselves and their families.

But we are heading into the last lap before coverage begins, with less than six months until open enrollment.  States and CCIIO should be furiously working with their IT vendors to make critical decisions on how state-based exchanges and the federally-facilitated exchange (FFE) will help consumers make the right choices for health plan selection.

What we do know about how consumers make choices, particularly in health care, should shape how the IT systems are designed to facilitate consumers’ plan selection.  Our knowledge about Medicare Advantage and Medicare Part D turns on its head the idea that more choice is good for consumers.  In fact, in important decisions like health insurance, too many choices can actually impair consumer decision-making.

That same research identifies important IT design interventions that can reduce the anxiety and confusion with health plan choice.  Websites can be designed to standardize the display, making it easy for consumers to compare and contrast plans.  They can provide screening tools and decision aids, present personalized information, and/or offer access, to trusted resources, such as navigators and assisters, to ease the decision making process.

Now is the time to ask your policy makers to show you their thinking.  We need to find out what they are planning for the section of the website for displaying health plan choice.   Any design decisions should be tested with real users, people who are likely to be shopping for exchange coverage or selecting from multiple Medicaid managed care plans. In our Advocates IT Toolkit, we identified a comprehensive list of features that should be included in the website design to support health plan selection:

• Include all of the information required by federal regulation to provide comparative QHP information, including premiums and cost-sharing, summary of benefits and coverage, plan level (i.e. bronze, silver, gold, platinum), quality ratings, consumer satisfaction surveys, medical loss ratio and more.

• Help consumers understand how to use the information to evaluate a plan. It should describe what’s in a “summary of benefits and coverage” and explain concepts such as what “medical loss ratio” means.

• Allow consumers to easily view and compare plan information.  The system should provide different ways to search, sort or filter QHP options, based on a consumer’s own personal criteria, to make the shopping experience more consumer-friendly. For example, consumers should be able to search for plans based on whether their doctor is in the network or the plan covers a specific prescription drug.

• Display a reasonable or “manageable” number of QHPs at any given time, with the opportunity to search additional data and choices as needed. Consumers (not the internal functionality of the system) should be in charge of selecting any criteria used to filter out plans. There should always be a clear indicator displayed that identifies when not all choices are currently showing.  The display should be simple and uncluttered, but also allow consumers to click through for more detailed information.

• Create a default sort order for QHP display that is clear to consumers. The order in which plans are displayed could influence a consumer’s choice. It is important that this be taken into consideration in providing plan information. For example, the system might display plans sorted by total estimated out of pocket costs or plan level (i.e. gold, silver or bronze).

• Provide the functionality for Medicaid managed care plan comparison and selection. Today, many states use expensive enrollment broker services for Medicaid managed care enrollment, with mixed results. Often there are delays in enrollment and many individuals ultimately are automatically assigned to plans. Allowing consumers eligible for Medicaid to compare and select plans in the same way that is expected in choosing QHPs in an exchange will be advantageous to both the consumer and the state.

The policy decisions behind the functionality of plan selection will undoubtedly impact the success of the ACA.  Putting time and effort in now to making it as easy as possible for consumers to compare and purchase plans will go a along way toward building consumer confidence in the exchanges and making the promise of the ACA a reality for millions of Americans.