A total of five health insurance companies -- including the
top three in the country -- have now agreed to comply with rigorous
new rules for physician ranking plans, setting a benchmark for the
development of a nationwide standard. United Healthcare and the
Group Health Insurance/Health Insurance Plan (GHI/HIP) of Greater
New York this week joined Aetna, CIGNA, and Wellpoint in accepting
the principles developed by New York Attorney General Andrew
Cuomo.
Aetna, Cigna, United, and WellPoint will apply the principles
nationwide.
The New York model expands on the principles for physician
tiering programs that the Massachusetts Medical Society adopted
earlier this month. The Massachusetts Group Insurance Commission
(GIC) requires its participating health plans to utilize a
proprietary ranking system. The system affects nearly 300,000 state
and municipal employees in Massachusetts.
"While the GIC has made some changes in its program in response
to physician concerns," said B. Dale Magee, M.D., president of the
Massachusetts Medical Society, "it has not been able to ensure
accuracy, reliability, or validity. It falls significantly short of
the New York attorney general's mandate for these principles, as
well as for independent oversight."
Cuomo's office drafted its model with input from the Medical
Society of the State of New York, the American Medical Association,
and several consumer advocacy groups. It requires insurers to fully
disclose all aspects of any ranking system and hire an independent
"ratings examiner" to monitor compliance.
The New York settlement agreements declare, "Consumers are
entitled to receive reliable and accurate information unclouded by
potential conflicts of interest. The independence, integrity, and
verifiable nature of the rating process are paramount."
"GHI and HIP believe that consumers must have access to accurate
and useful information about their physicians," said HIP's
executive vice president, Dan Dragalin, M.D.
According to a statement from Cuomo's office, insurers will:
- Ensure that rankings for doctors are not based solely on cost
and clearly identify the degree to which any ranking is based on
cost;
- Use established national standards to measure quality and cost
efficiency, including measures endorsed by the National Quality
Forum and other generally accepted national standards;
- Employ several techniques to foster more accurate physician
comparisons, including risk adjustment and valid sampling;
- Disclose to consumers how the program is designed and how
doctors are ranked, and provide a process for consumers to register
complaints about the system;
- Disclose to physicians how rankings are designed, and provide
a process to appeal disputed ratings;
- Nominate and pay for the ratings examiner, subject to the
approval of the New York attorney general, who will oversee
compliance with all aspects of the new ranking model and report to
the attorney general's office every six months. The ratings
examiner must be a "national standard setting organization" and
will be national in scope, independent, and an Internal Revenue
Code § 501(c)(3) organization.
United Healthcare had been scheduled to start its ranking
program in New York in December. It said it will comply with the
agreement before launching the program. GHI/HIP accepted the
agreement prior to designing its program.
