NCQA COMPLETES ASSESSMENT OF AETNA’S PHYSICIAN MEASUREMENT PROGRAM IN NEW YORK

Plans Reached 2007 Agreement with New York Attorney General; Results Available on Web

WASHINGTON— The National Committee for Quality Assurance (NCQA) today posted the results of its review of the efforts of Aetna Health Inc., an HMO/point-of-service plan, and Aetna Life Insurance Company, a preferred provider organization, to measure and report on physician performance for its plans in the state of New York. The review uses standards adapted from NCQA’s Physician and Hospital Quality program in accordance with an agreement reached between the health plans and New York Attorney General Andrew Cuomo. NCQA is designated as a Ratings Examiner under the agreement.  The results are available at nyrxreport.ncqa.org.

In 2007, seven health plans that had implemented a physician performance measurement program in New York reached agreement with the Attorney General’s office on a set of requirements for physician measurement programs. The Web site provides details on the extent to which health plans comply with provisions of the agreement. Such provisions include verification of the accuracy of measurement methods, the involvement of physicians in the program’s development, and the right of physicians to request changes or corrections to data.

Plans with physician measurement, rating and tiering programs must score 100 percent on reviews against the applicable requirements set forth in the agreement. Plans that are not in full compliance with the requirements must take corrective action and be reevaluated.

“Few decisions a patient makes hold greater sway over their health than their choice of a physician. Rating physicians fairly with trusted, transparent measures of quality gives patients a meaningful foundation for making these choices,” said NCQA President Margaret E. O’Kane.

“Aetna is pleased that our program aligns with NCQA’s standards. We are committed to offering members reliable information and tools so they can make the best decisions with their doctors about their health care. We will continue to base our programs on available evidence-based and externally validated measures to help ensure our programs are credible and useful to consumers,” said James Coates, MD, senior medical director, Aetna Informatics.

Reviews for CIGNA Healthcare of New York, an HMO, and Connecticut General Life Insurance Company’s PPO plan were posted in July. A review of United Healthcare is currently in process; their results will be made available later this year.

For more information, visit nyrxreport.ncqa.org.

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.  

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