CIGNA HealthCare has become the first health care plan to agree to submit its physician performance measurement program for independent review through a process established under a 2007 agreement with New York Attorney General Andrew M. Cuomo. With recent approval from the Attorney General, the National Committee for Quality Assurance (NCQA) will conduct the review in its role as the “Ratings Examiner” under the agreement, and will report its findings to the Attorney General. CIGNA expects the review to be completed by the end of May.
“We are committed to providing individuals with information about the quality and the cost of care as they make health care choices, and are eager to continue our work with the Attorney General to build a new national model for these programs,” said Jeffrey Kang, M.D., CIGNA chief medical officer. “NCQA is an established leader in the evaluation of health care quality and we look forward to their review and recommendations on how we can make these programs even more meaningful for consumers.”
“CIGNA was the first to adopt our Doctor Ranking Model Code, and is now the first to retain a ‘Ratings Examiner’ to oversee implementation of the Code,” said New York Attorney General Andrew M. Cuomo. “NCQA will help ensure that the core principles of the Code -- transparency and accuracy of information -– are met. This is a step in the right direction for both consumers and physicians.”
The Attorney General’s Doctor Ranking Model Code is the industry standard for programs that measure quality of performance and cost-efficiency of physicians. The Code requires insurers to ensure that rankings for doctors are not based solely on cost and clearly identify the degree to which any ranking is based on cost. In addition, insurers must use established national standards to measure quality and cost efficiency. Insurers must disclose to consumers and physicians how the program is designed and provide a process for physicians to appeal incorrect rankings. As relevant today, the Code also requires insurers to retain a Ratings Examiner to oversee compliance with the Code.
"Information about doctor quality can be a powerful tool for consumer choice, provided the data are fair, impartial and meaningful," said NCQA President Margaret E. O'Kane. "In the long run, this agreement will be a boon for New Yorkers and a model for others to follow. NCQA is pleased to be able to bring its expertise to the table."
NCQA is an independent, not-for-profit national standard-setting organization and is a leader in the efforts to develop effective strategies for communicating health plan information to consumers and other target audiences.
In March of 2007, CIGNA HealthCare became the first national health care plan to earn “Distinction” status across all of its 23 accredited plans for the way it measures the quality of care delivered by network hospitals and physicians. To earn NCQA distinction under the Physician and Hospital Quality standards, health plans must show that they measure the quality and cost of services provided by contracted physicians and hospitals using nationally recognized standards endorsed by outside organizations. Plans must be transparent about the methods they use to measure physician quality, provide physicians with advance information, and give physicians the opportunity to provide additional information. In addition, plans must demonstrate that they use the information in their efforts to improve health care quality and share the data with their customers.
About CIGNA HealthCare
CIGNA HealthCare, based in Bloomfield, CT, provides medical benefits plans, dental coverage, behavioral health coverage, pharmacy benefits and products and services that integrate and analyze information to support consumer engagement and health advocacy. "CIGNA HealthCare" and the “Tree of Life” logo are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation (NYSE:CI) and its operating subsidiaries, including Connecticut General Life Insurance Company. All products and services are provided exclusively by such operating subsidiaries, and not by CIGNA Corporation. For more information, visit www.cigna.com.
About NCQA
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes physicians in key clinical areas. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices. For more information, visit www.ncqa.org.