When you receive your evaluation letter, sign in to UnitedHealthPremium.UHC.com to view Version 11 evalution details for physician or group in the the Premium program.
The UnitedHealth Premium program provides physician designations based on quality and cost-efficiency criteria to help members make more informed choices about their medical care.
Physicians may also use these designations when referring patients to other physicians. Employers may choose to offer their employees a tiered benefit plan that may cost members less when they use Premium Care Physicians.
View the Version 11 Premium Program Overview for more information about the Premium program.
The UnitedHealth Premium reconsideration process allows physicians to request a correction or change to certain quality and/or cost-efficiency information included in their Premium evaluation.
Sign in to UnitedHealthPremium.UHC.com to review evaluation results or submit a reconsideration case request.
The Premium program consists of both quality and cost-efficiency assessments. Quality is the primary program measurement and is assessed using national standardized measures. Cost efficiency is assessed using two measurements: patient total cost and patient episode cost. The physician’s Premium specialty determines which measurement is applied.
The program evaluates physicians annually using updated quality and cost-efficiency methodologies and data. Physicians receive their designations based on a comparison of current version and previous version evaluation results.
In accordance with the principles of the Consumer-Purchaser Disclosure Project’s Patient Charter, the Premium program first uses clinical quality measures from the National Quality Forum (NQF) - Endorsed measures when available for the specialties being evaluated. The Quality Conditions, Procedures and Measures by Specialty lists the eligible programs for each Premium specialty.
Bridges to Excellence (BTE)
The Bridges to Excellence certification programs measure the quality of care delivered in provider practices. They place a special emphasis on managing patients with chronic conditions who are most at risk of incurring potentially avoidable complications. The Premium program may count individual recognition through a Bridges to Excellence program toward a physician’s quality assessment.
National Commission for Quality Assurance (NCQA)
National Commission for Quality Assurance Clinical Recognition Programs respond to a need for objective ways to demonstrate the quality of care rendered by physicians. NCQA also offers a recognition program for primary care physicians. The Premium program may count individual recognition through an NCQA program toward a physician’s quality assessment.