NCQA COMPLETES ASSESSMENT OF UNITED HEALTHCARE'S PHYSICIAN MEASUREMENT PROGRAM IN NEW YORK
Plans Reached 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 UnitedHealthcare Insurance Company of New York, Inc., two PPO/point-of-service plans operated by Oxford Health Insurance, Inc., and Oxford Health Plan, Inc., an HMO/point-of service plan, to measure and report on physician performance 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 use of standardized performance measures, disclosure of relevant methodologies, 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. UnitedHealthcare’s plans met seven of the eight requirements. The plans did not fully meet one requirement related to letters to physicians in response to their requests for reconsideration. UnitedHealthcare has subsequently revised its reconsideration letter to address the requirement. The plans will be reviewed again in April following the release of new physician designations.
“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.
“UnitedHealthcare applauds the New York Attorney General and NCQA for advancing the process by which this valuable information is made available to consumers,” said Sanford P. Cohen, M.D., chief medical officer for UnitedHealthcare’s Northeast region. “Working with physicians and other stakeholders to support performance improvement and measurement is the goal of our Premium designation program. We have worked closely with the New York Attorney General and NCQA to ensure that the UnitedHealth Premium program available today meets the requirements for physician measurement programs in New York.”
Reviews for Aetna Health New York (POS), Aetna Life Insurance Company of New York (PPO), CIGNA Healthcare of New York (HMO/POS) and Connecticut General Life Insurance Company (PPO) were posted earlier in the year. For more information, visit nyrxreport.ncqa.org.
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA evaluates, 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, protecting the lives of more than 100 million Americans. 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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