Six leading insurers have reached agreements with New York Attorney General Andrew Cuomo on physician-ranking programs, in an arrangement that could serve as a framework nationally. And the agreements have also spawned proposed legislation in the state.
Under the terms of the agreements, Aetna; Cigna Corp.; Empire Blue Cross and Blue Shield; Health Insurance Plan of Greater New York/GHI; MVP Health Care, a not-for-profit company, and its Rochester affiliate, Preferred Care; and UnitedHealth Group promised to adopt measures endorsed by the National Quality Forum and other reputable national standards in their physician ranking programs. The insurers 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 the insurers, will oversee compliance and report to the attorney generals office every six months.
Two top New York state lawmakers are backing legislation based on physician-ranking model.
The physician-ranking model, created with the American Medical Association, the AARP and Consumers Union, prohibits insurers from ranking physicians based only on cost.
The legislation being proposed today takes the necessary steps to ensure that New Yorkers making critical medical decisions are doing so armed with reliable and useful data, said state Assembly Speaker Sheldon Silver, in a written statement. State Senate Majority Leader Joseph Bruno also supports the bill.
The insurer agreements came after Cuomo sent letters to the insurers and others 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.
Other investigations are continuing.
This is good news for consumers who need information tools to help guide them through the health system and for physicians who deserve useful and accurate feedback, Reed Tuckson, executive vice president and chief of medical affairs for UnitedHealth Group said in a written statement.
We are committed to providing our members with a physician performance evaluation program that is easy to understand and takes into account the input of participating physicians, said Aetna Chief Medical Officer Troyen Brennan in a news release.
Cuomo announced the first doctor-ranking agreement with Cigna in late October.
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.
The attorney general did not find that Cignas program was based only on cost.
After the Empire Blues agreement was reached, Robert Goldberg, president of the Medical Society of the State of New York, expressed hope that it will become the cornerstone of all future relations on the subject with health insurance carriers, patients and physicians.
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.What do you think? Write us with your comments at [email protected]. Please include your name, title and hometown.