Group releases guidelines for health insurers’ physician measurement and reporting

On April 1, an organization made up of consumer, employer and labor organizations announced an agreement with health insurers and physician groups, including AAFP, to guide how health plans measure physicians’ performance and report the information to consumers.

The “Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs: Assuring Transparency, Fairness and Independent Review” establishes a national set of principles that will allow consumers to access more information on quality and cost with guidance on how to use the information, according to a press release from the Consumer-Purchaser Disclosure Project. The project, which is funded by the Robert Wood Johnson Foundation, aims to improve health care quality and affordability by supporting public reporting of provider performance information.

The Charter has two key elements for health plans. First, it details a set of criteria for assuring the relevance of measures to consumers, involvement of physicians, transparency of processes and core methodological expectations, and use of standardized measures. Second, it provides that health plans will retain an independent review of their processes, though the consumer reports will be assessed by an independent review organization and the results made public. The guidelines allow physicians to have adequate notice and the opportunity to correct any errors in the consumer reports, eliminating surprises, according to the press release.

“Performance measurement and public reporting go hand-in-hand to help continue to improve the quality of care all patients receive from their doctors and other health care providers,” Douglas E. Henley, M.D., said in the release. Henley is the AAFP executive vice president. “Because family physicians and other primary care doctors care for the majority of patients in the United States, we are the logical starting point to introduce a measurement and reporting system that is standard, fair and consistent.”

Other physician groups that endorse the effort are the American College of Physicians, the American Medical Association, the American College of Cardiology and the American College of Surgeons. Insurers who support the effort are America’s Health Insurance Plans, Aetna, Cigna, UnitedHealthcare and WellPoint.

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Read the press release from the Consumer-Purchaser Disclosure Project.