Tiering

In response to pressure from employers to hold down costs, all three of Minnesota's largest health plans — Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica — and the state of Minnesota have created tiered networks at the medical group, health system or care system level. There are currently no products in Minnesota that tier individual physicians.

Physician clinics that are judged by the health plan to be lower cost are placed in a lower tier and patients are given financial incentives to choose them.

The MMA supports efforts to provide patients with more information about the cost and quality of their heath care so they can make better decisions. The MMA does not, however, support the tiering of physicians if information is not made available on the methodology used to assign tiers and if validated benchmarks are not used when making quality comparisons.

The MMA developed the following criteria to evaluate Minnesota's tiered-physician-clinic products: valid cost analysis, tiering methodology transparency, tiering placement transparency, access to tiering data, value of cost and quality support tools provided to physicians' clinics, validity of quality metrics and relevance of quality metrics to primary care physicians.

Learn more

For more information, contact Janet Silversmith.


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