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.
Last Published 07.26.2022
Attribution methods based on health plan claims data determine which physicians are responsible for care given to patients.
Last Published 07.26.2022
The Premium program is available for commercial products in 45 states.
Last Published 09.23.2022
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 adjustment for patient episode costs and certain quality measures and risk adjustment for patient total cost.
Last Published 08.30.2022
The Premium program uses a five-step process to evaluate the physician’s cost efficiency performance and assigns a cost efficiency rating.
Last Published 07.26.2022
There are 2 measurements applied for the evaluation of cost efficiency: Patient total cost and Patient episode cost.
Last Published 07.26.2022
The Premium program excludes patient and episode cost outliers in the cost-efficiency evaluation.
Last Published 07.26.2022
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.
Last Published 08.01.2022
The UnitedHealth Premium® program’s cost-efficiency evaluation compares a physician’s cost-efficiency performance to physicians in the same Premium specialty and geographic area.
Last Published 07.26.2022
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
Last Published 08.24.2022
Patient episode cost reflects a combination of resource utilization, resource mix and unit cost. Episodes include services delivered to a patient related to a specific procedure or treatment of a condition.
Last Published 08.24.2022
Patient total cost is the risk-adjusted total cost per month for a patient. This includes services from episodes for conditions relevant to the scope of practice for the physician’s Premium specialty.
Last Published 07.26.2022
The Premium program evaluates physicians in 17 premium specialties representing 47 credentialed specialties.
Last Published 07.26.2022
The Premium program uses a 4-step process to evaluate the physician’s quality performance.
Last Published 08.24.2022
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 07.26.2022
Select 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 07.26.2022
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.
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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