ALBANY, N.Y., October 30 – CIGNA HealthCare will enhance its doctor ranking program, fully disclosing to consumers and physicians all aspects of its ranking system, under an agreement made with Attorney General Andrew M. Cuomo.

According to 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 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 generals 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 organization.

[We are working] with the attorney general to establish a national model for the entire health insurance industry, said Dr. Jeffrey Kang, chief medical officer of CIGNA. 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.

[The agreement] between the attorney general and CIGNA will provide a basic framework to ensure that plan efforts to rate physicians on certain quality and efficiency measures include fundamental transparency standards to guarantee a fair and sound ranking system that will ultimately benefit plan members, said Leslie S. Moran, spokeswoman for New York Health Plan Association. Plans are committed to working cooperatively with the Attorney Generals Office to make sure all New Yorkers have quality health care.

The agreement tracks efforts already underway in New York under the New York Quality Alliance (NYQA), a Department of Health-funded Pay for Performance Demonstration program, said Moran. The NYQA, a collaboration of 12 health plans [with] representatives from physician specialty groups, business and consumer organizations, will produce aggregated reports on physician performance. The performance reports will be based on 10 performance measures for ambulatory care drawn from the National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set data.

According to Moran, a recent report by the George Washington University School of Public Health and Health Services and the Robert Wood Johnson Foundation said, Physician rankings are a critical component of the broader movement to measure and publicly report on physician and hospital performance to help improve the quality and value of health care Americans receive.

Under this agreement, concluded Moran, New Yorkers will have access to these valuable informational tools.

The American Medical Association (AMA) commends CIGNA for leading the industry by renouncing physician evaluations and ranking based solely on economic factors, and agreeing to a balanced approach that acknowledges physician ratings have a risk of error and should not be the sole basis for selecting a physician, said Nancy H. Nielsen, MD, PhD, AMA president. The AMA expects this agreement will influence other states to implement careful and independent oversight and evaluation of physician performance measurement projects to assess their integrity and fairness.

This 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, said Nielsen. A lack of scrutiny has allowed health insurers to unfairly evaluate a physicians individual work using an insufficient number of patient cases, questionable quality measures and poor adjustments for risk. Consequently, patients could be presented with skewed and inaccurate information on caring physicians who were unfairly evaluated.

Patients should always be able to trust that the information they receive on physicians is valid and reliable, but the integrity of this information can be undermined by a health insurers corporate profit motive. This conflict of interest can erode confidence and trust in physicians, and disrupt patients longstanding relationships with physicians who know them and have cared for them for years.

Given the potential risk to patients, the AMA believes state lawmakers and regulators have an important public responsibility to establish proper oversight of health insurers to ensure that physician performance measurement is used primarily to enhance the quality of care, concluded Nielsen.

Accurately measuring physician performance is an evolving and complex practice, said Cuomo. Todays agreement creates greater transparency and accountability, and an oversight mechanism to ensure these principles are enforced. I encourage other insurers in New York and across the nation to step forward and adopt this model.

The agreement is the first made between a major insurer, (CIGNAs program operates in 28 states across the country), and a state 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.