Insurers agree to more transparent physician ratings

Two more health plans reach an accord with the New York attorney general to submit their tiered networks to outside scrutiny.

By Emily Berry, AMNews staff. Dec. 3, 2007.

Just weeks after it was signed, Cigna's agreement in New York to modify its physician ranking tool is set to have a ripple effect across the country.

Aetna and Empire BlueCross BlueShield, a WellPoint company, have signed similar agreements with New York Attorney General Andrew Cuomo's office. Aetna signed its deal on Nov. 13, while Empire followed the next day.

Aetna immediately pledged to apply the terms of its New York agreement to all of its tiered networks nationwide. Cigna made a similar pledge the same day Aetna did. WellPoint said it is not ready to make such a promise.

Under their separate deals, all three plans have agreed to make the basis of their physician ranking programs transparent to members, base those rankings on nationally recognized quality standards and submit their programs to outside evaluation.

Cuomo began looking into health plan physician-ranking programs this summer, based on concern that consumers would be directed to certain physicians based solely on cost, not quality.

"Attorney General Cuomo's model ensures transparency for both patients and doctors -- patients will now understand the criteria upon which doctors are ranked, and doctors will be able to provide input into the ranking system," said Robert Goldberg, DO, president of the Medical Society of the State of New York. Dr. Goldberg is a physical medicine and rehabilitation specialist in New York.

The Cigna Care Network designation for the plan's tiered networks is used in 58 markets from Los Angeles to Washington, D.C. At the time it signed its deal with Cuomo, Cigna said it was likely the parties would expand the reach of the agreement to cover its tiered networks nationwide, though it didn't make that announcement immediately.