“We are just at the very beginning of understanding how well these new tools take advantage of big data, information sciences (and) quality measurement (of a given network),” he said, “We just simply don't know how well we're going to be able to translate that knowledge into things that consumers can use.”
Joel Ario, managing director at Manatt Health Solutions and a former HHS director overseeing development of the federal exchange, said an important advance would be in predictive, personalized algorithms like Amazon's or Google's. In the future, he speculated, you might see patients upload their electronic health records to the exchange and have an algorithm point out which of their providers were in each plan's network, as well as each network's overall level of specialists who treat their particular medical conditions.
“You're never going to get the average consumer to understand all this detail,” Ario said. “You actually need people who are very skilled at creating the algorithms and other kinds of data analysis tools that help people sort these things out and put things in very simple terms.” And that information needed to be tailored and personalized.
Schuyler said constantly changing networks make it difficult to keep provider lists up to date, but ensuring information on each plan's network is accurate is of the highest importance.
At the Oregon conference, one insurance representative suggested putting a freshness date on the network information for each plan, to indicate when it was last updated. A proposed Washington state insurance rule change would mandate monthly updates. Schuyler thinks it's an issue the insurance industry needs to work on, though there's “no perfect solution to the problem.”
Such uncertainty also afflicts the search for new technology to better present such information. Andy Slavitt, the CMS' new principal deputy administrator, said last week that adding a specific tool on the HealthCare.gov website to help consumers identify each plan's network is off-the-table for the upcoming 2015 enrollment period. Instead, insurers will be encouraged to post accurate and up-to-date lists of providers.
Schuyler expects that such tools might have to wait a year or two until a product emerges that does a satisfactory job. The top priority is ensuring a smooth overall enrollment experience. But, he said, there's plenty of interest among vendors. “It offers a great opportunity to anybody who wants to provide a technology platform that can do a decent, reliable job,” he said.