Putting the quality in rankings

An agreement between the New York attorney general and Cigna promises to curtail flawed systems that rank physicians more on cost than on care.

Editorial. Dec. 3, 2007.

Who's a good doctor? Typically, it's a question of quality. Certainly, patients understand it that way. So do employers, who expect results after footing so much of the bill.

Yet many insurers have interpreted this query in their own, sadly predictable, fashion. To them, it's a question of how much the physician costs the health plan.

Such has been the history of tiered networks that claim to rank physicians by "quality," but use flawed means -- claims and cost data -- rather than credible quality measures. Employers are sold the plans on the basis of cost-effectiveness. The plans offer patients lower co-pays, deductibles or premiums to encourage them to select less costly practices for treatment. Even doctors who make the cut tell AMNews that the criteria used by health plans don't seem to have much to do with quality.

This has led to contentious battles between physicians and insurers. Some plans have delayed or altered tiered networks in the face of opposition from organized medicine, which in a few cases has sued the insurers.

However, there is new hope that physicians may soon expect to be rated on true quality measures, that the basis for ratings will be disclosed, and that errors will be corrected.

All this thanks to a groundbreaking agreement between the State of New York and Cigna Corp. The Oct. 29 deal grew out of Attorney General Andrew Cuomo's investigation of numerous health plans in his state that have, or intend to have, tiered networks. It marked the first such settlement between a state regulator and an insurer.