New York, CIGNA Agree on National Model for Physician Ranking Programs

Agreement Includes First-Ever Independent Oversight Monitor for Ranking
System

New York Attorney General Andrew M. Cuomo recently announced an agreement
with CIGNA HealthCare as part of his industry-wide investigation into doctor
ranking programs.

Under the agreement, CIGNA will enhance its doctor ranking program, fully
disclosing to consumers and physicians all aspects of its ranking system.
Additionally, CIGNA will retain an oversight monitor known as a Ratings
Examiner (“Rx�) who will oversee compliance with all aspects of the
agreement and will report to the Attorney General every six months.

“I applaud CIGNA for its leadership and cooperation in building a new
national model for doctor ranking systems, an achievement that fairly
balances the concerns of patients, doctors and insurers while providing
maximum information to consumers,� said Cuomo. “By working together with
CIGNA, consumer advocates, doctors and medical societies, we have been able
to create a new template for ranking programs that the entire industry can
follow.�

Doctor ranking programs are a rapidly growing practice within the healthcare
industry. CIGNA’s program alone operates in 28 states across the country.
Major insurers nationwide either operate or are in the process of developing
these programs. The New York/CIGNA doctor ranking agreement marks the first
such agreement between a major insurer and a state attorney general.

Under the agreement, CIGNA 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, including measures
endorsed by the National Quality Forum (NQF) and other generally accepted
national standards;

• Employ 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 incorrect 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.

“In addition to working with the Attorney General to establish a national
model for the entire health insurance industry, CIGNA will also contribute
up to $100,000 to an independent organization to develop better means of
communicating to consumers all aspects of the ranking program in a clear and
straightforward manner,� said Jeffrey Kang, MD, CIGNA chief medical officer.

“Accurately measuring physician performance is an evolving and complex
practice,� said Cuomo. “[This] agreement creates greater transparency and
accountability, and an oversight mechanism to ensure these principles are
enforced.�
Attorney General Cuomo previously sent letters to CIGNA and two other major
health insurers, Aetna and UnitedHealthcare, warning that their physician
ranking programs were likely to confuse consumers. Cuomo also issued letters
asking Empire Blue Cross Blue Shield to justify its planned ranking program,
Blue Precision, and calling on Preferred Care and HIP Health Plan of New
York/GHI to refrain from launching similar programs without first getting
the prior consent of the Attorney General.

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