Bill > S486

This bill aims to improve the quality and cost-efficiency of healthcare services by establishing new definitions for "quality," "cost efficiency," and "physician performance evaluation," and by setting specific requirements for how insurance carriers and government commissions implement physician performance evaluation programs. Key provisions include mandating public disclosure of evaluation methodologies, requiring input from practicing physicians and biostatisticians, establishing mechanisms for data accuracy and feedback, ensuring physicians receive detailed patient-level information, and setting clear targets for quality measures. The bill also addresses how physicians are evaluated, emphasizing that they should only be measured on conditions appropriate to their specialty and that preventive care should not be considered part of cost efficiency. Furthermore, it outlines requirements for tiered networks, ensuring patients have access to providers in lower cost-sharing tiers and that tiering decisions are data-driven and transparent, with provisions for group practices and protections for patients undergoing treatment when a provider's tier changes. The bill also mandates that carriers provide clear, understandable information about tiered and selective network plans to consumers.