UnitedHealth Premium® Program

Premium Program Methodology

Premium Program 2020 Updates

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.

The UnitedHealth Premium program evaluates physicians annually, using updated quality and cost efficiency methodologies and data. For the current version 13 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.

Learn More About the Premium Program

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. If the COVID-19 national public health emergency has affected the amount of time you need to review and request reconsideration of your results, please contact us for an extension to your reconsideration due date.

For more information on requesting reconsideration, please click here

The Premium program consists of both quality and cost-efficiency evaluations. Quality is the primary program measurement and is assessed using national standardized measures. Cost efficiency is evaluated 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.