UnitedHealth Premium® program (commercial plans) - Chapter 14, 2022 UnitedHealthcare Administrative Guide

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 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 2 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 and to support their efforts to provide quality and cost-efficient care to their patients. In markets where tiered benefit plans are available, employers may choose to offer their employees a tiered benefit plan. Tiered benefit plans may lower a member’s out-of-pocket costs for using Premium Care Physicians.

Some health care provider directories may display quality evaluation results only. In those directories, physicians who have met the Premium program’s quality care criteria 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. To contact us, go to UnitedHealthPremium.uhc.com > Help and Support > Contact Premium.