Massachusetts Insurers To Expand Health Plans With Physician Ranking System Despite Lawsuit

Main Category: Health Insurance / Medical Insurance
Also Included In: Primary Care / General Practice;  Litigation / Medical Malpractice
Article Date: 12 Jun 2008 - 11:00 PDT

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Two of Massachusetts' largest health insurers are expanding or launching health plans that feature physician ranking systems despite opposition to those systems by the Massachusetts Medical Society, the Boston Globe reports. Under such ranking systems, patients who seek care from a top-rated, or top-tiered, physician have lower copayments.

Officials from Tufts Health Plan, the third-largest insurer in the state, said that the company will expand its health plan and physician ranking system, called Navigator, to include additional medical specialties, such as cardiology, dermatology, neurology, ophthalmology and urology. Harvard Pilgrim Health Care, the state's second-largest insurer, said that it will consider expanding its physician ranking systems, called Independence, to residents not covered through the state's Group Insurance Commission, which purchases health insurance for most state employees and retirees.

The medical society in May filed a lawsuit against the Group Insurance Commission alleging that the ranking system defames physicians who provide high-quality and cost-efficient care but receive lower ratings and that the tiered systems defraud patients who have to pay higher out-of-pocket costs. Tufts Health and GIC were among the companies named as defendants in the lawsuit.

James Roosevelt Jr., CEO of Tufts Health, said that without a court order to stop Navigator, the company would continue developing the rankings system. He said, "This is a product that holds down prices." Under Tufts Health's expansion plans, the ranking system will shift from a two-tier system to a three-tier system, and plan members will contribute $15, $25 or $35 copays based on their physician's rating.

Frank Fortin, a spokesperson for the medical society, said, "There's no doubt that a lot of insurers are looking to experiment with physician rankings in the hope they would have an impact on cost," noting that at GIC, "there's no structure in place to track the cost savings, so you don't know if it's harmful or if it has a negative impact on access to care or quality." He added, "It's unscientific" (Krasner, Boston Globe, 6/10).

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