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 Emily Berry, AMNews staff. Dec. 10, 2007.

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.