BILL ANALYSIS
AB 2533
Page 1
Date of Hearing: April 21, 2010
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 2533 (Fuentes) - As Introduced: February 19, 2010
Policy Committee: Health Vote:19-0
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill requires health plans and health insurers (carriers)
to increase reporting related to quality ratings used by the
carriers and the medical groups and independent practice
associations they use. Specifically, this bill:
1)Requires carriers to report on quality rating, network
modification, the accuracy and reliability of data, and
patient compliance with medical procedures.
2)Expands current law reporting about economic profiling of
providers to include quality rating information. Economic
profiling refers to quantitative methods used by carriers to
stratify providers by specified factors in order to place
physicians in tiered networks, for which enrollees pay lower
co-pays or otherwise receive discounts for seeing favored
physicians.
FISCAL EFFECT
Minor and absorbable workload to the Department of Managed
Health Care (DMHC) and the California Department of Insurance
(CDI) to continue oversight of health plan and health insurer
reporting.
COMMENTS
1)Rationale . This bill is sponsored by the California Medical
Association (CMA) to increase the amount of information
provided by health plans and insurers about analysis of
providers with respect to quality ratings. According to the
author and sponsor, economic profiling and quality ratings are
AB 2533
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used increasingly by carriers, but have not been proven
reliable in many circumstances. The author and sponsor are
concerned that carrier analytical focus is primarily on costs
and claims, rather than quality of care or provider case mix.
This bill increases the information about and oversight of
carrier assessment of providers.
2)Background . Health plans and insurers, along with many in the
health care landscape, continue to pursue strategies to
control escalating medical costs while ensuring quality of
care. A focus of these efforts often involves physicians who
determine treatment decisions. Health plans are increasingly
introducing limited physician networks, offering patients
differential co-payments to encourage visits to certain
providers, and using bonus pay-for-performance for doctors who
are low utilizers of care.
Last month the New England Journal of Medicine (NEJM) published
a study evaluating the reliability of some of physician cost
profiling strategies and determined many methods are
unreliable in distinguishing between physicians. The NEJM
authors indicate the current methods for such profiling may
produce misleading results. This bill increases the
availability of information about California insurers'
approach to physician profiling.
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081