More health plans agree to New York model for physician rankings

Multistate plans pledging more transparency and quality-based ratings say they will apply those standards nationwide.

By — Posted Dec. 10, 2007

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The final three health insurance companies put on notice by New York Attorney General Andrew Cuomo's office for their physician-ranking programs have agreed to adopt transparency and accuracy standards for the programs and submit to outside oversight.

Following agreements in late November by UnitedHealth Group, Group Health Inc. and MVP Health Care, New York legislators announced their intention to make the attorney general's "best practices" a legal requirement for all plans in the state. Cigna, Aetna and WellPoint's Empire BlueCross BlueShield earlier agreed to similar deals with Cuomo.

United, WellPoint, Cigna and Aetna have said they will use the New York model for any tiered network program they would introduce anywhere in the United States and would reconstitute any current tiered networks already in place inside or outside of New York.

The model includes using independent quality measures to rate doctors without using cost as a factor. It also includes making public the measures that will be used and giving physicians the right to see the basis for their ratings and the right to appeal.

United was the first company that Cuomo's office contacted this year as part of an investigation into physician-ranking programs, in which plans rate physicians based on various factors and then allow patients to access the "best" doctors for a lower premium or co-pay.

In a letter to the company in July, Cuomo warned United about launching its Premium designation program in New York, saying the rankings could be misleading if based mainly on cost rather than quality. United had already agreed to push back introduction of its program to December before signing a deal with Cuomo on Nov. 20.

"We are witnessing the insurance market correcting itself," Cuomo said in a prepared statement. "I applaud UnitedHealthcare for working over the past several months with our office to improve their ratings system and waiting to make sure their program met our standards before launching it."

United's Premium designation is already available to more than 12 million of its members in 122 markets and will launch in New York by the end of the year, according to a company news release. The company said it looked forward to introducing a physician-ranking system under more transparent measures.

"The program set forth in this agreement, as compared to the one United rolled out earlier this year, represents a major accomplishment," said Robert Goldberg, DO, president of the Medical Society of the State of New York and a physical medicine and rehabilitation specialist.

Also before the Thanksgiving holiday, Group Health Inc./Health Insurance Plan of Greater New York, which has 4 million members in New York, New Jersey and Connecticut, agreed to adopt the attorney general's "best practices" if it eventually introduces a ranking or tiered network program.

MVP Health Care and its subsidiary Preferred Care announced a deal agreeing to similar terms at a Nov. 26 news conference, where New York state legislators announced their intention to make Cuomo's model state law.

Cuomo was joined at that event by, among others, Assembly Speaker Sheldon Silver, a Democrat from Manhattan, and Senate Majority Leader Joseph Bruno, a Republican from Brunswick, who both announced they intend to introduce a doctor-ranking model code. A bill has not yet been formally introduced.

The American Medical Association was among those advising Cuomo in his negotiations with health plans. AMA President-elect Nancy H. Nielsen, MD, PhD, an internist in Buffalo, N.Y., said the AMA "commends" legislators for "their attention to the public's welfare and their commitment to codifying the safeguards necessary to ensure the integrity of physician profiling initiatives."

Also, she said Cuomo "is to be credited for persuading many of the nation's largest health insurers to acknowledge the risks of physician profiling."

Cigna was the first to reach a deal with Cuomo's office, announced Oct. 29, eliciting praise from the AMA, the Medical Society of the State of New York and consumer groups.

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