A New York official has persuaded another health insurer to adopt a system he has developed for guiding health insurers’ doctor quality guides.
New York Attorney General Andrew Cuomo says Aetna Inc., Hartford, has agreed to use new New York doctor ranking program rules throughout the United States.
In October, the health care unit of CIGNA Corp., Philadelphia, agreed to adopt the rules, but Aetna will be the first that is applying the rules nationwide, according to officials in the New York attorney general’s office.
Earlier this year, Cuomo sent letters to a number of national and New York state health insurers asking them to put off implementing quality guide programs or to answer questions about existing programs.
The insurers say consumers need the guides to shop for health care, but Cuomo and others have argued that some of the ranking systems might be flawed, and some might put too much emphasis on cost and too little on quality of care.
Aetna, which provides or administers health coverage for 16 million people, has agreed to:
- Base physician rankings on quality information as well as cost and to identify how much cost contributes to the rankings.
- Employ several quality measures.
- Tell consumers how to register complaints.
- Tell doctors how to question what they believe to be unfair rankings.
- Pay an independent “ratings examiner” to oversee compliance and report to the attorney general’s office every 6 months.
In practice, the agreement means that Aetna will tell consumers how much of the evaluation process for the doctors in its Aetna Aexcel network is based on cost and how much on quality, officials say.
Cuomo put out a statement praising Aetna for agreeing to adopt the doctor ranking program rules.
“Health insurance companies are beginning to realize if they want to implement a doctor ranking program, they should adopt our national model, which is supported not just by insurers, but also by national physician and consumer groups,” Cuomo says in the statement.