Physician Tiering Information

In response to business interests in having greater transparency of costs and charges by physicians and hospitals in the health care system, many insurance companies throughout the country are introducing so-called “transparency and/or value-based, tiering” programs.

In Georgia, for example, Aetna has introduced the Aexcel Designation program, United Healthcare has introduced the United Health Premium physician designation and hospital comparison programs, and Cigna will be introducing the Cigna Care Network. These products attempt to stratify physicians and other health care providers into tiered or selected networks that are based primarily on cost of care.

As these programs are rolled out in Georgia, it is important for you to be aware of the programs’ existence and to know that MAG is fighting to assure that these programs are based on meaningful data and do not disparage physicians or interfere with the physician-patient contract. It is important for you to know that MAG has taken the following steps:

  • In an effort to educate our members, we have prepared a white paper entitled “Physician Tiering Programs in Georgia” to better explain these programs. The white paper is posted below.
  • We have expressed in writing our concerns with Aetna’s program Aexcel and are currently in discussion with them about the shortcoming in its program.
  • We are meeting with state elected officials to educate them about these programs.
  • Finally, we want to help you educate your patients about these programs. We have posted a “Notice To Patients” that you can copy and place in your waiting room. This notice is designed to educate your patients about the program and its shortcomings.

Important Supporting Documents

MAG Requesting Physician Reports on Health Plan Tiering: Aetna Aexcel Designation; United Health Premium and Cigna Care

During recent months, many physicians have received letters from Aetna and United Health Care informing them whether they passed certain quality of care and efficiency measures for special designation under new or revised “Tiering” programs. These reports are often placed on the health plans’ Web site for viewing by patients and, reportedly, for health plans to move patients to higher quality and more efficient physicians.

MAG has received several reports from physicians about inaccuracies in these reports, including the addition of hospital charges in the physician profile. MAG is concerned about the misrepresentation of physician’s profiles based on inaccurate data and would like to hear from you. If you have noticed improper or incorrect data included, please send MAG copies of your designation report and background data. The information can be e-mailed, faxed or sent to:

Donald Palmisano, General Counsel, dpalmisano@mag.org
Cam Grayson, Director, Third Party Payer Advocacy, cgrayson@mag.org
Medical Association of Georgia
1849 The Exchange
Suite 200
Atlanta, GA 30339
Fax: 678.303.3732