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Aetna's Physician Rating Gets NCQA OK


 

The full report on Aetna's compliance is available at http://nyrxreport.ncqa.org

Aetna Inc.'s physician-rating program recently received a passing grade from the National Committee for Quality Assurance.

The evaluation was aimed at addressing allegations that health plans were using physician-rating programs to steer members to less expensive providers. To date, seven state, regional, and national insurers have pledged not to base their physician rankings entirely on cost. The health plans have also agreed to involve physicians in measure development and to allow physicians to review their performance data and request changes.

In the most recent evaluation, NCQA reviewed the compliance efforts of Aetna Health Inc., an HMO-point of service plan, and Aetna Life Insurance Co., a preferred-provider organization, both operating in New York. The plans were found to be in full compliance with the eight requirements reviewed by NCQA.

Aetna officials said they were pleased with the results and committed to continuing to offer physician-rating information to members. “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,” Dr. James Coates, senior medical director for Aetna Informatics, said in a statement.

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