by New York State AG | 11/22/2007 8:15:56 AM
Five Insurers in Three Weeks Adopt Model Created Together with National Medical and Consumer Groups
NEW YORK, NY (November 20, 2007) – Attorney General Andrew M. Cuomo today announced an agreement on doctor ranking programs with Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP).
With this agreement, a total of five insurers have adopted the Attorney General’s doctor ranking model. The others are CIGNA Healthcare, Aetna, Empire Blue Cross Blue Shield, and UnitedHealthcare. CIGNA, Aetna, and Empire’s parent, WellPoint, will also apply the principles of the Attorney General’s doctor ranking model nationwide. GHI and HIP provide health benefits to over four million people in the tri-state area.
This model was created in consultation with the American Medical Association and the Medical Society of the State of New York, along with a host of consumer advocacy groups including the Consumers Union and the National Partnership for Women & Families. The North Shore Physician Organization also provided key assistance to the Attorney General’s doctor rankings initiative.
“Major insurers are lining up to embrace our national model for doctor rankings. This model is supported by both doctors and consumers and has become the industry standard,” said Cuomo. “I applaud GHI and HIP for being the first insurers to preemptively accept our model before having any plans to design a program. As their commitment shows, insurers considering a program for rating doctors can and should use the national model as their foundation.”
“GHI and HIP believe that consumers must have access to accurate and useful information about their physicians,” said Dr. Dan Dragalin, Executive Vice President and Chief Medical Officer of HIP.
“A standard of measurement that is transparent and accurate and open to review by physicians and accrediting organizations is a solid foundation for any programs in the future. For this reason, even though we do not have a physician ranking program, we signed this agreement.” said Dr. Aran Ron, President of GHI.
“The American Medical Association applauds GHI and HIP for joining the growing number of insurers who are adopting this model,” said the American Medical Association's President-Elect, Dr. Nancy Nielsen. “Patients and physicians need to be sure that any system for ranking doctors is accurate and fair. We are very pleased that Attorney General Cuomo has made accountability to physicians and patients in doctor ranking programs a widely accepted standard within the insurance industry.”
“Consumers and insurance members stand to benefit greatly from today’s agreement,” said Debra Ness, President of the National Partnership for Women & Families. “Consumers deserve to know what factors go into ranking their doctors, and should be able to easily choose the doctor that is best for them. The more insurers that adopt this model, the more consumers will be able to do just that.”
"Thanks to the leadership of Attorney General Cuomo more and more insurers are adopting doctor ranking programs that provide patients with clear and comprehensive information, and that accurately reflect the quality of health care provided by doctors," said Dr. Robert Goldberg, President of the Medical Society of the State of New York. "This model provides transparency in the way ratings are created and ensures a level of independence by the inclusion of an oversight examiner reporting to the Attorney General. Doctors are well served by having major insurers in New York and nationwide adopting this model."
The model reforms doctor ranking programs by compelling insurers to fully disclose to consumers and physicians all aspects of their ranking system. Additionally, under this model, the insurer must retain an oversight monitor, known as a Ratings Examiner (“Rx”), who will oversee compliance with all aspects of the agreement and report to the Attorney General every six months.
Under the national model, 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 (NQF) and other generally accepted national standards;
• Employ several measures 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 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.
Doctor ranking programs are a rapidly growing practice within the healthcare industry. Major insurers nationwide either operate or are in the process of developing these programs.
Today’s agreement with GHI and HIP covers the following related companies: GHI, GHI HMO Select, Inc., Health Insurance Plan of Greater New York (HIP), HIP Insurance Company of New York, Inc., The PerfectHealth Insurance Company, ConnectiCare of New York, Inc., ConnectiCare Insurance Company, Inc., ConnectiCare of Massachusetts, Inc., and ConnectiCare, Inc.
The Attorney General’s industry-wide investigation of doctor ranking programs is ongoing and is being handled by Linda Lacewell, the head of the Attorney General’s Healthcare Industry Taskforce.