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N.Y. Attorney General Focuses on Health Plans’ Doctor Rankings

August 23, 2007
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The New York Attorney General’s Office is seeking information about programs used by Aetna Inc. and a Cigna Corp. unit to rank doctors based on quality and cost-effectiveness.

In letters sent to the two insurers on Thursday, August 16, Attorney General Andrew M. Cuomo expressed concern that the physician rating programs of Hartford, Connecticut-based Aetna and Philadelphia-based Cigna carry “a significant risk of causing consumer confusion, if not deception.”

The attorney general expressed similar concerns in a letter sent to a unit of Minnetonka, Minnesota-based UnitedHealth Group Inc. last month.

The programs—Aetna’s Aexcel and Cigna Care Network—are designed to encourage consumers to choose specialists based on quality and efficiency metrics and may be used by employers offering financial inducements such as lower co-payments and deductibles to promote cost-effective doctors, according to the letters.

The companies rely on claims data in ranking specialists, but claims data is known to carry “significant risks of error,” such as not including all relevant clinical information and not accounting for situations when one patient is treated by multiple physicians, according to the letters.

“Consumers are entitled to transparency when making the important decision of choosing their doctors, including specialists,” the letters say. “The goal of transparency is defeated, however, if the information provided is itself inaccurate or misleading or based on flawed data.”

In addition, the networks were developed without disclosing the data used to rank the doctors, even to the physicians themselves, giving doctors and consumers no ability to point out errors in the rankings, the letters say.

The attorney general is seeking information on numerous aspects of the program, including how a physician’s performance and cost-effectiveness is measured and the process for physicians who wish to challenge their rankings.

“We learned about the letter today and are still in the process of reviewing it, so it would be inappropriate to make any substantive comments,” a spokesman for Cigna said in a statement. “We take the attorney general’s concerns seriously and will respond to his request for information.”

In a statement, an Aetna spokeswoman said the company is “fully committed to transparency,” including publishing the criteria for the selection of specialty physicians on member and provider Web sites. The company discusses its programs with physician organizations prior to rolling them out—as it did in New York, where the program has been available since 2005—and also has mechanisms for physicians to raise concerns they may have with their own data, the spokeswoman said.

“Doctors are designated if they meet certain thresholds first for clinical performance and, only then, cost-efficiency,” the spokeswoman said in the statement.

Aetna will review the attorney general’s request and cooperate fully, she said.

The assertions featured in the Aetna and Cigna letters are similar to the ones featured in a July letter sent to UnitedHealthcare. For example, in all three letters the attorney general’s office expressed concern that the insurers’ profit motives may affect the accuracy of its quality rankings because high-quality doctors may be more expensive, creating a potential conflict of interest.

Unlike the UnitedHealthcare letter, though, the attorney general’s office simply asks for more information regarding the programs from Aetna and Cigna. The letters sent Thursday to the two insurers do not ask them to cease their doctor ranking programs, and they do not discuss the possibility of an injunction against the programs, as in the UnitedHealthcare letter.

Filed by Gloria Gonzalez of Business Insurance, a sister publication of Workforce Management. To comment, e-mail editors@workforce.com.

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