This week, Empire Blue Cross Blue Shield became the third New York health plan to adopt a physician ratings model created by state Attorney General Andrew Cuomo. In agreeing to the model, Empire will disclose more information on its physician rankings system, and will hire a "ratings examiner" to oversee compliance with the new rules. The ratings examiner will make a report every six months to the Attorney General on how well Empire is complying--and then Empire will meet with the AG to review the report.
Among other things, the new standards require that Empire makes sure that ratings aren't based solely on cost--and that it discloses the extent to which physician costs are a factor. It will adopt national standards, endorsed by the National Quality Forum or other similar groups, to rate clinical quality. Empire will also let doctors and consumers know how the rankings work, and give them a chance to complain if they're unhappy.
Empire, the largest health plan in New York, is owned by WellPoint, and has about five million members. Over the past couple of weeks, two other large health insurers doing business in New York (CIGNA and Aetna) have signed similar agreements with the state.
To learn more about the agreement:
- read this press release from the New York state AG
- read this Modern Healthcare piece
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