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Post date: November 14 2007

Empire Blue Cross Blue Shield Enters Into An Agreement With New York Attorney General For Doctor Ranking Programs

NEW YORK, NY (November 14, 2007) – Attorney General Andrew M. Cuomo today announced that the largest health insurer in New York State, Empire Blue Cross Blue Shield (“Empire”), has agreed to adopt the Attorney General’s model for doctor ranking programs.

Empire is owned by WellPoint (NYSE: WLP), the nation’s largest health insurer. Empire is the WellPoint subsidiary in New York and the largest health insurer in the state, with approximately five million members.

As part of the agreement’s guidelines, Empire will make information to consumers and physicians available regarding all aspects of its ranking system. In addition, Empire will retain an oversight monitor known as a Ratings Examiner (“Rx”), which will oversee compliance with all aspects of the agreement and will report to the Attorney General every six months. Empire and the Attorney General will meet every six months to review the information the company is compiling.

This model was created in consultation with, and is supported by, the American Medical Association and the Medical Society of the State of New York, along with a host of consumer advocacy groups including the Consumers Union.

“Together, my team has worked with Empire to reach agreement on a model for doctor ranking programs that sets a new standard for all insurers to meet. Our agreement will encourage the nation’s leading insurers to line up to adopt similar principles of accuracy, transparency, and oversight, establishing our model as the norm within the industry,” said Attorney General Cuomo. “I applaud Empire and its parent company, WellPoint, for leading the way on this issue.”

“We are proud of our 75 year history of working with physicians, hospitals and government and to now build on that history in our efforts to develop industry leading transparency programs that will help our members make informed health care decisions,” said Mark Wagar, president and CEO of Empire Blue Cross Blue Shield. “We want to develop programs of the highest quality that benefit both New York consumers and providers with fair and actionable data.”

“The involvement of physicians, hospitals and other health care professionals in the design and implementation of programs that recognize quality performance is essential,” said Dr. Sam Nussbaum, executive vice president and chief medical officer of WellPoint, Empire’s parent company. “This is new territory, not just for us, but for the entire industry. Measuring the performance of physicians is a complex and rapidly evolving process. These guidelines will provide the industry with the building blocks needed to further enhance and refine the programs we have in place, as well as those under development.”
Under the new model, Empire will:

Ensure that rankings for doctors are not based solely on cost and clearly identify the degree to which any ranking is based on cost;
Use established national standards to measure quality and cost efficiency, including measures endorsed by the National Quality Forum (NQF) and other generally accepted national standards;
Employ several measures to foster more accurate physician comparisons, including risk adjustment and valid sampling;
Disclose to consumers how the program is designed and how doctors are ranked, and provide a process for consumers to register complaints about the system;
Disclose to physicians how rankings are designed, and provide a process to appeal incorrect rankings;
Nominate and pay for the Rx, subject to the approval of the Attorney General, who will oversee compliance with all aspects of the new ranking model and report to the Attorney General’s office every six months; the Ratings examiner must be a “national standard setting organization” and will be national in scope.
Doctor ranking programs are a rapidly growing practice within the health care industry. Major insurers nationwide either operate or are in the process of developing these programs.

(Statements by the American Medical Association, Medical Society of the State of New York and the Consumers Union are attached)


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