Medica's Premium Designation Program
Medica’s Premium Designation Program is a United HealthCare-developed program that United HealthCare has already launched in a variety of other states. Medica adopted the program without any changes or modifications for the Minnesota community. The program provides public displays of cost and quality performance, based on claims data alone, at the individual physician level for board-certified physicians in twenty (20) different specialties.1 Although the MMA supports quality measurement for clinics and physicians at the group level, the MMA opposes Medica’s Premium Designation program - the first attempt by an insurer in Minnesota to publicly rate individual physicians.
On December 3, 2010, Medica notified Minnesota physicians of its plan to publicly release cost and quality rankings of individual physicians as part of its Premium Designation Program. Approximately 9,400 physicians were notified of their cost and quality results – displayed as 0-2 stars – and were only given until December 24, 2010 to request a formal reconsideration (error correction) of any of the data used in their results.
The MMA retained a national expert to evaluate the Medica program and the conclusions of that review found three key flaws:
- Failure to include Minnesota network physicians in the program’s development process;
- Inadequate amount of time for physicians to review their performance measurement data and results and to provide feedback on identified errors;
- Failure to provide for explicit measurement of reliability, and failure to limit reporting of individual results to physicians whose performance scores meet agreed upon standards of reliability.
The incorporation of reliability measurement in rating programs has been shown to be extremely important. An analysis of a similar physician rating program in Massachusetts found that 22 percent of the physicians were likely to be misclassified (e.g., a low cost physician erroneously ranked as high cost or a low cost physician erroneously ranked as high cost).2
Examples of errors in the results as reported by physicians to the MMA include a physician being penalized on his quality score for not ordering a pap smear for a woman who had a complete hysterectomy nine years earlier, and many physicians being inaccurately assigned to specialty categories.
Despite the MMA’s request to delay the public release of the results until the known flaws and errors could be addressed, Medica proceeded to release the results on January 19, 2011.
The MMA remains concerned that Medica’s program includes inaccurate information about individual doctors, misleads patients, and undercuts Minnesota’s positive quality improvement efforts that rely on collaborations between providers and insurers.
1 Specialties included are: Family medicine, pediatrics, obstetrics/gynecology, internal medicine, allergy, cardiology, cardiology-interventional, cardiology-electrophysiology, endocrinology, nephrology, neurology, orthopedics-general, orthopedics-hip/knee, orthopedics-hand, orthopedics-foot/ankle, orthopedics-shoulder/elbow, orthopedics-spine, neurosurgery-spine, pulmonology, and rheumatology.
2 Adams JL. Mehrotra A. Thomas JW. McGlynn EA. Physician cost profiling--reliability and risk of misclassification. NEJM 2010;362:1014-1021