Lessons from Mass. on how to measure success of health insurance marketplaces

By Tom Lyons

UMass Medical School Communications

November 04, 2013
   Jay Himmelstein, MD, MPH

Once the technical problems that marked the launch of Healthcare.gov and some state-based health insurance marketplaces are fixed, these online portals will forever change the way people shop for and buy health insurance in the United States.


However, evaluating the effectiveness of marketplaces in achieving the goals of the Accountable Care Act is still a work in progress. Developing meaningful performance metrics is the subject of a new Health Affairs blog post co-authored by two UMass Medical School health policy experts, along with colleagues from the Commonwealth Health Insurance Connector Authority (Health Connector) and the Blue Cross Blue Shield of Massachusetts Foundation.

The authors, including Jay Himmelstein, MD, MPH, professor of family medicine & community health and chief health policy strategist in the Center for Health Policy and Research, and Scott Keays, MPH, project associate in the Office of Health Policy and Technology, believe that accurately measuring the success of health reform will be a crucial task for states, especially those operating state-based marketplaces.

Drawing on Massachusetts’ unique experience of establishing the nation’s first health insurance marketplace, Himmelstein and Keays, along with co-authors Roni Mansur, deputy executive director and chief operating officer at the Massachusetts Health Connector, and Kaitlyn Kenney Walsh, director of policy and research at the Blue Cross Blue Shield Foundation of Massachusetts, say that states should begin now to build marketplace performance metrics that go beyond those currently required by the Centers for Medicare and Medicaid Services.

The Health Connector, established in 2007 as part of Massachusetts’ groundbreaking health care reform law, built a robust system to evaluate progress of expanding health insurance coverage. The agency relied not only on data generated through its marketplace, but also on information from a variety of other state agencies, including the Department of Revenue, the Division of Health Care Finance and Policy, and the Division of Insurance.

By utilizing multiple streams of data, Massachusetts was able to bridge gaps in information and ensure that future policy was informed by the best possible information. For example, based on the Health Connector’s work, policy makers were able to reliably report that the overall insurance rate rose from a baseline of 93 percent in 2006, to nearly 98 percent today (including 99 percent of children). This system of data collection, evaluation and analysis has played an important role as the state has expanded its focus from increasing access to health insurance to emphasizing the importance of improving quality and making health care more affordable.