Health Insurers’ Physician Ranking Programs Spark Concerns About Consumer Deception: Investigation by New York Attorney General Leads to Agreement

New York Attorney General Andrew M. Cuomo has been conducting an industry-wide investigation of doctor ranking programs, concerned that the insurers use their ranking system to steer their insureds to doctors who cost the insurers less but are not as well qualified to treat the insured as physicians who are more expensive for the insurer to pay. This investigation has led to an agreement, announced earlier this week, with healthcare industry leader, CIGNA Healthcare, regarding its doctor ranking programs.

Investigations performed under the leadership of the Attorney General show that consumers cannot rely on these programs blindly. Previously, in letters to Aetna, United Healthcare and Cigna, Cuomo questioned the insurers’ use of claims data to rank specialists.

According to Cuomo, claims data does not contain complete information and can skew rankings. He also criticized the insurers for failing to disclose the accuracy of the rankings and said insurers “have a profit motive” to recommend physicians who cost less but might not be the most qualified. His office is concerned that the ranking programs cause consumer confusion and deception.

Doctor ranking programs are a rapidly growing practice within the healthcare industry. CIGNAs program alone operates in 28 states across the country. Major insurers nationwide either operate or are in the process of developing these programs.

Attorney General 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 agreement is intended to better ensure full disclosure to all relevant parties about all details covering these programs. For instance, CIGNA is to divulge to doctors and consumers all aspects of its ranking program, including how rankings are designated. Further, it was agreed that ranking would not solely be based on cost and the measurement of quality is to be according to national standards. There also will be a “Ratings Examiner” who will make sure that CIGNA is complying with all aspects of the agreement, and this same individual is also expected to report to the Attorney General twice a year.

It is hoped that the whole medical insurance industry will follow and adhere to these guidelines, thereby increasing the flow of information to all necessary parties. This agreement will be instrumental in helping consumers make more informed decisions in terms of their medical care. It is also expected that the public documentation of a physician’s performance based on quality and cost will augment the physicians’ performances.

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