Public health insurance exchange decision support tools improved somewhat in year two open enrollment compared to year one, but still have a way to go, research shows.

Researchers from the Perelman School of Medicine at the University of Pennsylvania analyzed and 12 state-run exchanges by looking at data consumers would see before creating an account, commonly called the window shopping phase, as well as after creating an account and having their identities verified.

The researchers found that decision tools most likely to be helpful to consumers were more common in the second as compared to the first open enrollment period, but still not universally available. The researchers found that while most sites allowed consumers to sort or filter plans by premium and deductible amounts, only three states had out-of-pocket cost estimators that “did the math” for consumers by adding together premium and expected costs, such as deductibles and copays based on consumers’ predicted use.

While Covered California listed plans in order of this estimated out-of-pocket cost from cheapest to most expensive, most sites the researchers analyzed used the premium amount as their default order, failing to account for most out-of-pocket expenses, such as a high deductible. All but six sites reviewed also failed to provide a tool to allow consumers to search plans for a provider network.

The research was published in the August 18 issue of the Annals of Internal Medicine medical journal.

“Selecting a plan is a complex task for just about anyone, regardless of your knowledge of the marketplaces or health insurance, and the way plans are presented on the exchanges and the tools available there can influence consumers' choices,” says Dr. Charlene A. Wong, the study’s lead author, and a Robert Wood Johnson Foundation Clinical Scholar. “Performance of the health insurance marketplaces will significantly depend on such features as the order in which plans are displayed, the plan features listed, and the availability of decision support tools created for consumers.”

“While we generally found improvement in the second versus the first open enrollment period, additional measures can and should be added in the future to further improve the selection process for consumers,” she adds.


While the UPenn report says there is improvement needed, Katherine Hempstead, a director at the Robert Wood Johnson Foundation, believes open enrollment three, which starts later this year, will see more decision support tools, especially on the federally-facilitated marketplace.

One “huge development” is that Enroll America has partnered with a start-up, Clear Health Analytics, to produce a comparison tool for their site, “This will give everyone in a state access to a high quality comparison tool at no cost,” she says. “A number of companies that make decision tools, including Stride Health, have announced plans to expand to all 50 states.”

The Centers for Medicare and Medicaid Services has required carriers to post machine readable provider directory and formulary files in states for the 2016 plan year. “These will be immediately grabbed by developers to improve existing tools and create new ones,” Hempstead says. “Some state-based marketplaces will additionally offer new plan choice tools, although it may well be the case that the states overall will have better access to decision support in” the third open enrollment.

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