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NYS Attorney General announces agreement with Cigna and its doctor ranking program

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Attorney General Andrew M. Cuomo yesterday (10/29) announced an agreement with one of the nation’s largest health insurers, CIGNA HealthCare (NYSE: CI), as part of his industry-wide investigation into doctor ranking programs.

A press release issue by the office of the NY State Attorney, stated that 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.

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. Today’s 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 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 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. 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.
  • 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. Earlier this month, 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 providing details about their systems and getting prior consent of the Attorney General.

    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.

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