Table 1.
Summary Statistics of Marketplace Insurer-Product Characteristics and Quality Measures
| QRS quality metric | Insurer type | |||||
|---|---|---|---|---|---|---|
| Summary indicator, domain, composite | ALL | PSHP | NFP | MMCO | Blue | PPO |
| Clinical quality management | 3.20 (0.86) | 3.53 (0.85) | 3.31 (0.95) | 2.81 (0.72) | 3.25 (0.73) | 3.00 (0.90) |
| Clinical effectiveness | 3.21 (0.88) | 3.57 (0.89) | 3.36 (0.87) | 2.61 (0.88) | 3.28 (0.71) | 3.16 (0.88) |
| Asthma | 2.80 (0.92) | 2.70 (1.03) | 2.82 (0.91) | 2.47 (0.99) | 2.96 (0.72) | 3.07 (0.88) |
| Behavioral health | 2.92 (0.93) | 3.24 (0.93) | 3.09 (0.93) | 2.32 (0.84) | 3.09 (0.80) | 3.06 (0.78) |
| CVD | 3.61 (0.93) | 3.95 (0.94) | 3.78 (0.93) | 2.99 (0.95) | 3.69 (0.75) | 3.52 (1.01) |
| Diabetes | 3.35 (0.85) | 3.74 (0.93) | 3.52 (0.92) | 2.92 (0.75) | 3.31 (0.74) | 3.12 (0.86) |
| Safety | 3.72 (0.78) | 3.80 (0.69) | 3.69 (0.81) | 3.75 (0.85) | 3.79 (0.61) | 3.62 (0.88) |
| Prevention | 3.64 (0.83) | 4.03 (0.77) | 3.72 (0.94) | 3.11 (0.77) | 3.69 (0.64) | 3.41 (0.92) |
| Cancer | 3.18 (0.97) | 3.64 (0.90) | 3.39 (0.99) | 2.44 (0.85) | 3.33 (0.79) | 3.13 (0.89) |
| Maternal health | 3.26 (1.03) | 3.82 (1.00) | 3.37 (1.15) | 2.70 (0.87) | 3.23 (0.95) | 2.93 (1.11) |
| Staying healthy adult | 2.78 (0.91) | 3.11 (0.91) | 2.92 (0.99) | 2.58 (0.87) | 2.73 (0.81) | 2.42 (0.89) |
| Staying healthy child | 3.25 (1.04) | 3.61 (1.04) | 3.29 (1.12) | 2.84 (0.96) | 3.39 (1.01) | 3.06 (1.08) |
| Enrollee experience | 3.03 (0.86) | 3.28 (0.78) | 3.11 (0.80) | 2.59 (1.00) | 3.08 (0.71) | 3.44 (0.77) |
| Plan efficiency, affordability, and management | 3.46 (0.84) | 3.84 (0.87) | 3.57 (0.89) | 3.10 (0.62) | 3.22 (0.77) | 3.19 (0.71) |
| N | 381 | 133 | 219 | 72 | 107 | 83 |
Data are from Centers for Medicare and Medicaid Services Quality Rating System 2019 and 2020 databases. Insurer types were identified with the 2016 National Association of Insurance Commissioners report and the Robert Wood Johnson Foundation’s Marketplace insurer-type data. Among five insurer types, only Medicaid focus (Medicaid-managed care organization or MMCO) and Blue Cross affiliate are mutually exclusive. More details can be found in Appendix Table A2. Insurer-product type is classified by insurer’s non-profit ownership, Blue Cross Blue Shield affiliation, Medicaid focus, preferred provider organization status, and whether the plan was vertically integrated with a provider organization (“provider-sponsored health plan” or PSHP). The scores of QRS measures are organized into a hierarchical structure to produce the overall score and rating. The QRS hierarchy is provided in Appendix Figure 1, and details can be found in the 2021 QRS and QHP Enrollee Survey Technical Guidance