OK SB1358

Requires insurers offering health benefit plans in Oklahoma to adopt a physician performance reporting program by January 1, 2012 to measure and tier physicians based on quality and cost-efficiency.

Mandates insurers hire an independent ratings examiner (a national standard-setting organization) to oversee compliance with transparency, accuracy, and methodology requirements, with annual reports to the Insurance Commissioner.

Requires physician performance measures use nationally recognized evidence-based guidelines (National Quality Forum or AQA endorsed measures preferred) and appropriate risk adjustment for patient population characteristics.

Directs insurers to disclose detailed methodologies and data to both consumers and physicians, provide physicians 45-day notice before new evaluations, and establish a transparent appeals process with ratings examiner oversight.

Applies to group health plans, HMOs, PPOs, and state employee insurance but exempts short-term, accident, disability, workers' compensation, Medicaid, and auto insurance coverage; becomes effective November 1, 2010.