Jul 20, 2018

Version 11 evaluation letters are being mailed. Sign in to UnitedHealthPremium.UHC.com to view evaluation details.

Version 11 evaluation lette...
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Jul 20, 2018

Due to planned maintenance, Link will be unavailable from 10 p.m. Central Time on Friday, July 20, until 2 a.m. on Saturday, July 21. We apologize for any inconvenience.

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2017/2018 Premium Methodology

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 assesses 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 assessment results.

The physician’s quality assessment result is determined by comparing quality measure performance to a case-mix adjusted benchmark.

The Premium program first uses clinical quality measures from the National Quality Forum (NQF) ‒ Endorsed measures, when available, for the specialties being assessed. Those are supplemented with others, as necessary, to assess clinically important conditions and specialties.

For more information about the medical management of specific conditions, click on the following Evidence-Based Medicine synopses from Symmetry Evidence-Based Medicine Connect:

There are two measurements applied for the cost-efficiency assessment: patient total cost and patient episode cost. The physician’s Premium specialty determines which measurement is applied. The Premium program compares the physician’s cost-efficiency performance to a case-mix adjusted benchmark and then applies a statistical test to determine if there’s a statistically significant difference. Each measurement has its own statistical result.

View the Cost-Efficiency Assessment and Statistical example to learn more about how the six-step process is used to assign a physician’s cost-efficiency assessment result.

Cost-Efficiency by Specialty

  • Allergy: Includes Allergy, Allergy and Immunology
  • Cardiology: Includes Cardiac Diagnostic, Cardiology, Cardiovascular Disease, Clinical Cardiac Electrophysiology, and Interventional Cardiology
  • Ear, Nose and Throat (ENT): Includes Laryngology, Otolaryngology, Otology, Pediatric Otolaryngology, Rhinology, Surgery Head and Neck
  • Endocrinology: Includes Diabetes, Endocrinology and Metabolism
  • Family Medicine: Includes Family Practice, General Practice, and Preventive Medicine
  • Gastroenterology: Includes Digestive Diseases, Endoscopy, Gastroenterology, and Hepatology-Liver Disease
  • General Surgery: Includes Colon and Rectal Surgery, Hand Surgery, Proctology, Surgery, and Surgery Abdominal
  • Internal Medicine: Includes Internal Medicine
  • Nephrology: Includes Nephrology
  • Neurology: Includes Neurology, Neurology and Psychiatry, and Neuromuscular Disease
  • Neurosurgery, Orthopedics and Spine (NOS): Includes Back and Spine Surgery, Hand Surgery, Knee Surgery, Neurological Surgery, Orthopedic Surgery, Shoulder Surgery, and Sports Medicine
  • Obstetrics and Gynecology (ObGyn): Includes Gynecology, Obstetrics, Obstetrics and Gynecology
  • Pediatrics: Includes Adolescent Medicine, Pediatric Adolescent, and Pediatrics
  • Pulmonology: Includes Pulmonary Medicine
  • Rheumatology: Includes Rheumatology
  • Urology: Includes Urology 

To determine a physician’s quality assessment result, the Premium program compares the physician’s quality measure performance to a case-mix adjusted benchmark and then applies a statistical test to determine if there is a statistically significant difference. The quality assessment result is assigned based on the statistical result.

View the Quality Assessment and Statistical example to learn more about the seven-step process used to assign a physician’s quality assessment result.

  • Allergy: Includes Allergy, Allergy and Immunology
  • Cardiology: Includes Cardiac Diagnostic, Cardiology, Cardiovascular Disease, Clinical Cardiac Electrophysiology, and Interventional Cardiology
  • Ear, Nose and Throat (ENT): Includes Laryngology, Otolaryngology, Otology, Pediatric Otolaryngology, Rhinology, Surgery Head and Neck
  • Endocrinology: Includes Diabetes, Endocrinology and Metabolism
  • Family Medicine: Includes Family Practice, General Practice, and Preventive Medicines and Metabolism
  • Gastroenterology: Includes Digestive Diseases, Endoscopy, Gastroenterology, and Hepatology-Liver Disease
  • General Surgery: Includes Colon and Rectal Surgery, Hand Surgery, Proctology, Surgery, and Surgery Abdominal
  • Internal Medicine: Includes Internal Medicine
  • Nephrology: Includes Nephrology
  • Neurology: Includes Neurology, Neurology and Psychiatry, and Neuromuscular Disease
  • Neurosurgery, Orthopedics and Spine (NOS): Includes Back and Spine Surgery, Hand Surgery, Knee Surgery, Neurological Surgery, Orthopedic Surgery, Shoulder Surgery, and Sports Medicine
  • Obstetrics and Gynecology (ObGyn): Includes Gynecology, Obstetrics, Obstetrics and Gynecology
  • Pediatrics: Includes Adolescent Medicine, Pediatric Adolescent, and Pediatrics
  • Pulmonology: Includes Pulmonology Medicine
  • Rheumatology: Includes Rheumatology
  • Urology: Includes Urology

Procedure Episode Group (PEG) quality measures are based on major therapeutic surgical procedures and the services associated with them. The quality measure is attributed to the physician who performed the major procedure associated with it.

For the UnitedHealth Premium designation program, your quality assessment result is determined by comparing your quality measure performance to a case-mix adjusted benchmark.

For more information about the medical management of specific procedures and measures, click on the following 2017/2018 quality procedure measure synopses: