Raise the Bar: State-Based Marketplaces Using Quality Tools to Enhance Health Equity

Commonwealth Fund May 22, 2024
Jalisa Clark, Christine Monahan

One of the ways the Affordable Care Act (ACA) sought to improve health care quality was by establishing a Quality Improvement Strategy (QIS) program and Quality Rating System (QRS) for health coverage sold through the ACA marketplaces. More recently, the federal government has begun using the QIS program and QRS parameters to advance health equity. Federal rules now require all marketplace insurers to adopt a strategy for reducing health disparities and to stratify certain clinical data by race and ethnicity.

While state-based marketplaces (SBMs) have authority to supplement these federal minimum QIS and QRS standards with state-specific quality rules, most have hewed closely to the federal default approach. California and Washington are notable exceptions. Each has implemented a customized QIS...

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