Cigna reach agreement on physician ranking system

New York state Attorney General Andrew Cuomo (D) on Monday said that Cigna has agreed to provide its members with more information on how it ranks physicians, the AP/Hartford Courant reports. Cuomo said the deal could set a national standard for physician ranking systems (Bauman, AP/Hartford Courant, 10/29).

Cuomo in August warned Aetna and Cigna that their physician ranking programs likely would confuse or mislead members because of problems with the information used to rank physicians. In July, Cuomo warned UnitedHealth Group to cancel the launch of a similar program or face possible legal action (Kaiser Daily Health Policy Report, 8/21).

Under the agreement, Cigna will divide its preferred physician list into three lists -- one that ranks by cost, one that ranks by quality and one that uses a combination of both measures. Cigna said that it always has used both cost and quality measures to rank physicians, but the insurer in the agreement pledged to make its ranking data more transparent to members (AP/Hartford Courant, 10/29). The agreement will require that Cigna report to the attorney general every six months and that it use an outside monitor, Cuomo's office said on Monday. Jeffrey Kang, chief medical officer at Cigna, said that the insurer also will contribute up to $100,000 to an independent organization to research ways to improve the presentation of the data to help consumers understand the system (Bloomberg/New York Times, 10/30).

Aetna said it will work with Cuomo on a similar deal. UnitedHealth and WellPoint's Empire Blue Cross Blue Shield said they are discussing arrangements as well (Fuhrmans, Wall Street Journal, 10/30). According to CQ HealthBeat, it is becoming increasingly common for insurers to create systems that rank physicians (Reichard, CQ HealthBeat, 10/29). Medical groups and some state regulators have expressed concerns that doctor rankings can be confusing and could be used to steer patients to the least-expensive health care providers, rather than the highest-quality (Wall Street Journal, 10/30).

Comments
American Medical Association President-elect Nancy Nielsen supports the agreement, saying that it "will influence other states to implement careful and independent oversight and evaluation of physician performance measurement projects." Nielsen said that the agreement "is important because it establishes a process that seeks to guard against some of the risks inherent in physician performance programs run by health insurers." She added, "A lack of scrutiny has allowed health insurers to unfairly evaluate a physician's individual work using an insufficient number of patient cases, questionable quality measures and poor adjustment for risk" (CQ HealthBeat, 10/29).

Cuomo said, "Quality doesn't have to be the enemy of cost, but they have to be different measures" (Wall Street Journal, 10/30). In a statement, Cuomo said, "Accurately measuring physician performance is an evolving and complex practice. Today's agreement creates greater transparency and accountability" (AP/Hartford Courant, 10/29).