MINNEAPOLIS, Updated 2:47 p.m. CDT September 6, 2006 -- The Minnesota Medical Association (MMA) released a report Tuesday that grades health plan tiering programs that slot physician clinics into tiers on the basis of cost and sometimes quality measures.

The MMA supports tiering efforts as a way to provide patients more information. However, it found shortcomings in the way insurers are tiering clinics.

MMA President David Luehr was quoted in Wednesday’s Star Tribune as saying that the MMA is calling on insurers to provide more information concerning the methodology used to place physicians in different tiers.

"We support the idea of getting information to the patient, and tiering is one way to do that," Luehr said in the article. "It just needs to be done right. We need quality information, cost of care information, so you get valid data points to check on tiering."

The state of Minnesota received low marks for its MN Advantage, which lags behind Blue Cross, HealthPartners and Medica on most criteria. Minnesota Advantage is the only plan that doesn't use any quality measures to assign tiers.

“A clinic that is spending more money to provide medical care that patients need and getting better results could be rated as less efficient than a clinic that spent less, did less, and didn't have as good results," Luehr said in an MMA press release.

In general, health plans use cost, rather than quality, as the driving element in assigning tiers and overstate the weight they give quality in assigning tiers, Luehr said. "The MMA is urging health plans to be clear about how much they take quality into account when they make tiering decisions."

Another limitation of tiering efforts is that physicians often cannot know how reliable or valid the methods are that are used to calculate the cost of care. Health plans are making decisions based on the tiering software packages that are available, but research suggests that plans' decisions about how to implement and use that software can affect the accuracy of the results.

Blue Cross, HealthPartners, and Medica score fairly well on transparency, providing "advanced" information about tiering methodology to physicians, and "basic" information to enrollees. The state's Advantage Health Plan, however, provides only "limited" information to enrollees.

To correct this situation, the MMA is asking health plans and the state to give physicians more information about the criteria used to set the cut-off line between tiers and to determine where physician groups rank.

The MMA based its rankings on the amount of information given to physicians and enrollees including:
• the methodology used to tier physicians,
• the criteria for cut-off decisions between tiers;
• data that determined tiering placements,
• usefulness of information about cost and quality of referral, and treatment options,
• access to data on which quality measures are based, and
• relevance of quality measures.

To see the report, “The Tiering of Minnesota Physicians,” and get background information, click here.