Plan Choice Decision Support Rules for Health Insurance Exchanges

Through the Helping Vulnerable Consumers in the Exchange Project, the Pacific Business Group on Health (PBGH) [1] is developing plan choice decision support rules that exchanges can use to build their consumer choice software requirements. The rules are informed by consumer plan choice research performed by decision science experts at Columbia, Penn and Stanford Universities. Topics include ways to organize the dimensions of health plan choice and to solicit consumer’s preferences about dimensions that are important to them. The initial experiments provide strong evidence that choosing a health plan is a very difficult task for many people.

In this webinar sponsored by the State Coverage Initiatives (SCI), Ted von Glahn, Senior Director at PBGH, highlighted the business rules completed to date and demonstrated how those rules can be used in adopting plan choice software requirements. Participants learned how they can put these business rules to use through vendor negotiations and eligibility and enrollment system design and heard discussions on key challenges exchanges may face in implementation. As background, the first installment of the business rules has been posted above – these rules will be refined and updated as the experiments continue through September 2012.

During the webinar, state officials from Alabama, Minnesota, and Rhode Island also presented their reactions to the plan choice decision rules, and discussed how they are thinking about integrating plan choice research into their IT systems and business processes.