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. In markets where tiered benefit plans are available, employers may choose to offer their employees a tiered benefit plan with a lower member cost share for using Premium Care Physicians. For this release, the Premium program uses claims submitted and processed for dates of service prior to the President's proclamation declaring the COVID-19 national public health emergency.
Last Published 07.09.2021
Attribution methods based on health plan claims data determine which physicians are responsible for care given to patients.
Last Published 07.09.2021
The Premium program is available for commercial products in 45 states.
Last Published 07.09.2021
For both the quality and cost-efficiency measurements, the Premium program compares the physician’s performance to a case-mix adjusted benchmark. Case-mix adjustment accounts for variations in the composition of the patients and cases each physician treats. The Premium program uses severity adjustments for certain quality measures and patient episode cost measurement, and risk adjustments for patient total cost measurement.
Last Published 07.09.2021
The Premium program uses a five-step process to evaluate the physician’s cost efficiency performance and assigns a cost efficiency rating.
Last Published 07.09.2021
The UnitedHealth Premium program provides physician designations based on quality and cost-efficiency criteria to help members make more informed choices for their medical care. Physicians may also review these designations when referring patients to other physicians. In markets where tiered benefit plans are available, employers may choose to offer their employees a tiered benefit plan, which may provide an enhanced benefit in the form of lower member cost share for seeing a Premium Care Physician.
Last Published 07.09.2021
The Premium program evaluates physicians in 16 premium specialties representing 47 credentialed specialties.
Last Published 07.09.2021
The Premium program uses a four-step process to evaluate the physician’s quality performance.
Last Published 07.09.2021
The Premium program includes National Committee for Quality Assurance (NCQA) recognition programs in the quality evaluation. The Premium program adds 25 measures or 10% of the physician’s total measures ‒ whichever is larger ‒ as compliant measures, to the quality evaluation for physicians who have achieved recognition in one or more of these programs applicable to their Premium specialty.
Last Published 07.09.2021
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 and to support their efforts to provide quality and cost-efficient care to their patients. Specific states have requirements governing physician measurement programs that are different from other standard UnitedHealth Premium program processes. In these states, the Premium program may follow different or additional processes for physicians who are evaluated by the program.
Last Published 07.09.2021
The UnitedHealth Premium program applies statistical tests to determine if there is a statistically significant difference between the physician’s performance and the target benchmark. When there are a sufficient number of quality measures attributed, the chi- square goodness of fit test (for statistical significance) and the phi coefficient (for effect size, or absolute difference) are used to determine if the physician’s performance isn’t statistically less than the target benchmark. When there are a sufficient number of patients and/or episodes attributed, the Wilcoxon rank-sum test is applied to determine if the physician’s performance is statistically less than the target benchmark.
Please see Premium Program News on UnitedHealthPremium.UHC.com
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.
For more information on requesting reconsideration, please click here.
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