An agreement over physician-ranking programs between Cigna Corp. and New York Attorney General Andrew Cuomo could lead to similar agreements involving other insurers and serve as a framework nationally.
The agreement reached last week came after Cuomo sent letters to Aetna, Cigna, UnitedHealth Group and other insurers in the past six months asking for more information on their physician-ranking programs, saying they may confuse or deceive consumers.
His office wrote that Aetna Aexcel, Cigna Care Network and other programs may be flawed because the insurers rely on claims data, which can exclude key information and have too small a sample size to yield useful data. The attorney general also raised questions over whether the programs were based solely on cost as opposed to quality and other factors.
Under the terms of the agreement reached with Cuomo, Cigna promised to adopt measures endorsed by the National Quality Forum and other reputable national standards. The insurer will use risk-adjustment and valid sampling data to compare physicians and disclose to consumers and physicians details on the ranking design. A ratings examiner, paid for by Cigna, will oversee compliance and report to the attorney generals office every six months.
The attorney general did not find that Cignas program was based only on cost.
Nancy Nielsen, president-elect of the American Medical Association, in a statement praised Cuomo and Cigna for agreeing to a balanced approach that acknowledges physician ratings have a risk of error and should not be the sole basis for selecting a physician.
Aetna spokeswoman Cynthia Michener said in an e-mail that the insurer welcomes working with Cuomo on a similar agreement and to sharing details of our program with a nationally recognized external entity.
Cuomo on Oct. 18 expanded his investigation to Empire Blue Cross and Blue Shield, Preferred Care in Rochester, N.Y., and the Health Insurance Plan of Greater New York/GHI in New York City.
The Empire Blues said the outline of the New York attorney generals agreement with Cigna appears consistent with the general principles of Empires transparency efforts, according to a spokeswoman. But UnitedHealth criticized the attorney generals handling of the issue. Spokesman Tyler Mason said Cuomos office notified the New York Times of the investigation two days before notifying UnitedHealth, back in July. He added that many features in the Cigna deal are already in UnitedHealths physician-ranking program.
Americas Health Insurance Plans has been working with the American College of Physicians, American Academy of Family Physicians and the Agency for Healthcare Research and Quality since 1994 to develop physician performance measures. Susan Pisano, spokeswoman for AHIP, said those efforts should dovetail with agreements reached in New York.