UnitedHealth PremiumŪ Designation Program
To recognize that not all health care is created equal, UnitedHealthcare created the UnitedHealth Premium designation program. The program evaluates physicians using evidence-based, medical society, and national industry standards with transparent methodology and robust data sources to evaluate physicians across 25 specialties to advance safe, timely, effective, efficient, equitable and patient-centered care.
The quality criteria come from evidence-based medicine standards and national guidelines published by clinical societies, and input from leading physicians practicing in specialty areas. The evaluation of physicians for cost efficiency uses population cost and/or episode cost measurement as appropriate depending on the specialty being assessed. Population cost measurement is used for the cost efficiency evaluation for both primary care physicians and for select specialty physicians. For both episode cost and population cost measurement, physician costs are evaluated against their peer group's costs.
There are several possible Premium designations for a physician. Physicians who have met the criteria for quality and/or cost efficiency could have one of these four UnitedHealth Premium designations.
- Quality & Cost Efficiency
- Cost Efficiency & Not Enough Data to Assess Quality
- Quality & Not Enough Data to Assess Cost Efficiency
- Quality & Did Not Meet Cost Efficiency
Other possible designations include:
- Not Enough Data to Assess Quality & Did Not Meet Cost Efficiency
- Not Enough Data to Assess
- Not Evaluated
- Did Not Meet Quality & Cost Efficiency
The fact that a doctor does not have a quality designation does not mean that the doctor does not provide quality health services. All doctors who are part of the UnitedHealthcare network must meet our standard credentialing requirements (separate from the Premium program).
The assessment result "Not Enough Data to Assess" is not an indicator of the total number of patients treated by the doctor or the number of procedures performed by the doctor. Rather, it reflects the statistical requirements of the program.
For more information on the UnitedHealth Premium program, visit UnitedHealthPremium.com. For details on the methodology we use to evaluate physicians in the Medica Service Area (Minnesota, North Dakota, South Dakota and portions of western Wisconsin), click here. For Connecticut, Delaware, New York, New Jersey, Pennsylvania and Rhode Island, click here. For all other states, click here. If you would like to provide feedback on the program, please send an email to PremiumProgram@uhc.com.