Aetna has struck a deal with New York Attorney General Andrew Cuomo under which it will adopt a model limiting its approach to rating physicians. The new model, which is backed by the AMA and the state's medical society, requires insurers to share all details on how they rank doctors with both consumers and the physicians themselves. Aetna will adopt the model both in New York state and across the U.S. The announcement follows a similar one by CIGNA, which said last month that it would adopt a Cuomo-backed model for its physician ratings programs nationwide. Prior to striking the agreement, Aetna's "Aetna Aexcel" program rated physicians on 12 categories touching on clinical quality and cost efficiency. However, previously Aetna had not been in the practice of letting consumers know to what extent cost impacted their ratings.
Without a doubt, Cuomo's deals with these health plans will prove influential nationally. However, while the new model may address more of physicians' concerns, there's always the issue of whether health plans "cook the books" to make sure cheaper physicians win regardless of publicly-stated criteria. My feeling is that keeping such programs fair is going to be a bear (and that if no one monitors them, they won't be worth the paper they're written on). Let's face it--health plans have a strong financial incentive to steer patients to cheaper doctors, so their gaming the system is pretty much guaranteed.
To learn more about the deal:
- read this Business First of Buffalo piece
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