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UnitedHealth Premium Designation Program (Commercial Plans) - Chapter 13, 2019 UnitedHealthcare Administrative Guide

UnitedHealth Premium Designation Program

The UnitedHealth Premium® program provides physician designations based on quality and cost-efficiency criteria. This helps members make more informed choices for their medical care.

This program includes both quality care and cost-efficient care evaluations. Quality is the primary measurement. The emphasis on quality demonstrates our commitment to evidence-based medicine as only those physicians who meet quality standards are evaluated for cost efficiency. The results of these evaluations are used to determine a designation that we publicly display. Quality is evaluated using national standardized measures. Cost efficiency is evaluated using two measures: patient total cost and patient episode cost.

Physicians receive one of these designations:

Premium Care Physician

The physician meets the UnitedHealth Premium program quality and cost-efficient care criteria.

Quality Care Physician

The physician meets the UnitedHealth Premium program quality care criteria, but does not meet the program’s cost-efficient care criteria or is not evaluated for cost-efficient care.

Does not Meet Premium Care

The physician does not meet the UnitedHealth Premium program quality criteria so the physician is not eligible for the Premium designation.

Not Evaluated for Premium Care

The physician’s specialty is not evaluated in the UnitedHealth Premium program, the physician does not have enough claims data for program evaluation, or the physician‘s program evaluation is in process.

Physicians may review these designations when referring patients to other physicians. Employers may choose to offer their employees a tiered benefit plan. Tiered benefit plans may offer an enhanced benefit of lower out-of-pocket costs for using Premium Care Physicians.

Some directories may display quality evaluation results only. On those, physicians with the Premium Care Physician or Quality Care Physician designation may be displayed as a Quality Care Physician.

For more information regarding the UnitedHealth Premium program, including measures, measurement methodology and how we use the results, go to UnitedHealthPremium.UHC.com or call 866-270-5588.