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New NCQA Web Site Details New York Health Plans Performance on Standards of Physician Quality Measurement

July 31, 2008

A new Web site launched by the National Committee for Quality Assurance (NCQA) provides for the first time detail on the extent to which health plans in New York measure and report on physician performance in accordance with an agreement reached between the health plans and New York Attorney General Andrew Cuomo. The plans were assessed by NCQA–designated as a Ratings Examiner under the agreement–using standards adapted from the organization’s Physician and Hospital Quality program.

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, nyrxreport.ncqa.org, 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.

“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. “Our Web site takes physician rankings out of the black box and sheds light upon what goes into plans’ physician measurement efforts.”

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

“New Yorkers deserve to know what goes in to a doctor’s ‘high-performance’ designation from a health plan,” said Attorney General Cuomo. “Ratings examiners such as NCQA provide independent verification that these rankings are arrived at equitably and are based on sound science. This is a terrific step forward for physicians, patients and health plans alike.”

The first plans to have their results displayed on the site are CIGNA HealthCare of New York, an HMO, and Connecticut General Life Insurance Company, also a CIGNA company. “We’re proud that CIGNA’s programs were the first to be reviewed under this national model for physician evaluation programs, consistent with our agreement with the New York Attorney General, and we’re pleased with the results of that review,” said Dick Salmon, M.D., National Medical Director for CIGNA HealthCare. “We want the individuals we serve to know that the information we make available about the performance of physicians is based on identified clinical measures and fairly applied. Our goal is to provide people with information that they can use, along with other data and advice from their current doctor, when choosing a specialist.”

Reviews for Aetna and United Healthcare are currently in process; their results will be made available later this year.

Plans are reviewed on standards are adapted from NCQA’s Physician and Hospital Quality program. The standards, first released in 2006, evaluate health plans’ efforts to measure and report on physician and hospital performance. NCQA released an updated version on the certification–available to organizations nationwide–in June.

To view the performance of health plans against the standards, visit http://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(R)) 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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