ALBANY, N.Y., November 13 – Aetna, the third largest health insurer in the country with over 16 million members nationwide, has become the second insurer to adopt New York State Attorney General Andrew M. Cuomos model for doctor ranking, and is the first in the country to apply it.

Aetna is proud to be among the first insurance companies to adopt the attorney generals national model and to be the first to work with consumer groups to apply the principles of the agreement nationally to our program, said Troyen A. Brennan, M.D., Aetnas chief medical officer. We are committed to providing our members with a physician performance evaluation program that is easy to understand and takes into account the input of participating physicians. Thanks to the attorney general, we now have the ability to strengthen our program to make it consistent with a model across insurance carriers to the benefit of all consumers that is accurate, transparent and fair for all parties. Aetna is committed to transparency of information to physicians, members, and employers who purchase health plans.

Aetnas existing program, known as Aetna Aexcel, designates physicians in 12 specialty categories who have passed certain clinical quality and cost efficiency measures. Before this agreement, Aetna did not identify to its consumers how much of the evaluation process was based on cost efficiency and how much on quality measures, which Aetna will now do.

Another Step Forward

Choosing a doctor is obviously a very important decision, and the information health care companies provide to consumers must be fair and complete, said Cuomo. 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. I commend Aetna for being among the first to step forward, and I encourage other insurance companies who are considering doctor ranking programs to follow Aetnas example.

[This] agreement between the attorney general and Aetna is another step forward on the road to providing consumers valuable information about the performance of physicians they use, said Paul Macielak, president of the New York Health Plan Association.

While health plans have been held accountable for the quality of care provided to their members for well over a decade with annual report cards ranking each plans performance, theres been virtually no information on the performance of individual doctors caring for plan members, Macielak continued.

He added, We hope these agreements between the attorney general and plans will not result in overlapping oversight and regulatory conflict with the federal Centers for Medicare and Medicaid Services (CMS) and the state Department of Health and Department of Insurance.

Macielak concluded, Although the agreements to date represent a move toward providing consumers with valuable information, they also highlight the growing need for consumer access to information about physician charges prior to receiving services. Only in health care are consumers expected to guess at the quality of physician performance and learn of the costs after the care is rendered.

Under Cuomos national model, insurers 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.