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Empire BlueCross BlueShield and New York Attorney General Reach Agreement on Guidelines for State Doctor Ranking Programs
Date:11/14/2007

New Agreement Will Help Ensure Consumers and Health Care Providers Receive Clear and Meaningful Information about the Quality and Cost of their Care

NEW YORK, Nov. 14 /PRNewswire/ -- Empire BlueCross BlueShield and New York Attorney General Andrew M. Cuomo announced today that Empire has reached an agreement with the Attorney General on a model for the establishment and oversight of certain physician measurement programs in New York.

The model establishes "best practices" for the marketplace to measure physician quality and performance with respect to the measurement of physician ranking programs. These same practices have been advocated by several key industry stakeholders, including physicians and employers, to improve the quality of care delivered to consumers.

"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 to develop industry leading programs that help our members make informed health care decisions," said Mark Wagar, president and CEO of Empire BlueCross BlueShield. "We want to develop programs of the highest quality that benefit both New York consumers and providers with fair and actionable data."

The focus of the agreement is two-fold. The first is to provide members with clear and meaningful information. Second, to recognize that participating physicians and other health care providers that deliver direct medical care to members every day need to be part of the discussion and the solution. Any programs developed need to be fair and transparent to providers enabling them to use the data to improve the care they deliver. The principles and guidelines in this agreement strongly reinforce this focus.

"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."

Empire is planning to implement later next year a program known as Blue Precision which measures performance of common physician specialty practices. The Blue Precision network would consist of specialists who meet the standards of clinical quality and cost-efficiency, determined in accordance with the guidelines developed by Empire and the Attorney General's office. Empire and the Attorney General's office will work to identify a suitable oversight organization prior to deploying Blue Precision in New York. Blue Precision has been successfully rolled out by nine plans owned by Empire's parent company in other states.

The agreement between New York Attorney General Andrew Cuomo and Empire is available at http://www.empireblue.com.

About Empire BlueCross BlueShield

Empire BlueCross BlueShield (Empire) is the trade name of Empire HealthChoice Assurance, Inc., and Empire BlueCross BlueShield HMO is the trade name of Empire HealthChoice HMO, Inc., independent licensees of the Blue Cross Blue Shield Association, serving residents and businesses in the 28 eastern and southeastern counties of New York State. Empire BlueCross BlueShield, the largest health insurer in New York State based on PPO and HMO membership, is a subsidiary of WellPoint, Inc. Additional information about Empire is available at http://www.empireblue.com.


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SOURCE Empire BlueCross BlueShield
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