New physician designations to feature more claims, quality measures

On Sept. 26, 2018, UnitedHealthcare will release updated UnitedHealth Premium® Program designations for eligible network physicians.

UnitedHealthcare is committed to enhancing the Premium program to promote access to quality and affordable health care. The key changes to the program include:

  • Updated claims data – For this release, we’re using claims data from Jan. 1, 2015 through Feb. 28, 2018.
  • Updated quality measures – Measures have been updated using Symmetry version 9.2 tools. These tools use updated specifications for evidence-based quality measures.
  • Enhanced designation criteria  We compare the current evaluation result to the previous version when determining the designation. For this release, in addition to the existing criteria where we use the current evaluation result, if the current version has a statistically higher cost efficiency result we will use the current evaluation result to determine the designation.

Premium Care Physicians represent the 16 specialties and 47 subspecialties that meet program benchmarks for quality and cost efficiency. UnitedHealthcare assesses quality using national standardized measures, starting with clinical quality measures from the National Quality Forum (NQF) endorsed measures. Those measures are supplemented with others as necessary to assess clinically important conditions and specialties.* The annual evaluation of UnitedHealth Premium designations takes place prior to Open Enrollment to allow members to verify a physician’s Premium status in the upcoming calendar year before enrolling in a tiered benefit plan. Updates will be reflected in and mobile applications on Sept. 26.

The value of tiered benefit plans is optimized by achieving market requirements for Tier 1 access, savings and stability. This release focused on increasing the stability of Tier 1 (Premium Care Physicians) while maintaining access and savings from the previous release.

For provider directory display, existing Tier 1 physicians will retain their Tier 1 status display through the end of 2018 with the exception of those physicians who no longer meet the Premium quality criteria. Claims from physicians losing their Premium Care Physician designation, including those who no longer meet the Premium quality criteria, will continue to pay at Tier 1 through the end of 2018.

This release also focused on improving the provider experience by deploying a new Premium website for physicians ( The website provides data access for physicians to better understand the Premium program and their designation. Physicians, administrators or delegates can use the website to view premium program designation details, submit reconsideration requests, obtain program methodology, or access program resources and training.

Please contact your UnitedHealthcare representative for questions or more information.

*Additional measures are selected from or developed using published literature and information from organizations such as the AQA Alliance (formerly the Ambulatory Care Quality Alliance), National Committee for Quality Assurance (NCQA), American Medical Association Physician Consortium for Performance Improvement® (PCPI®), specialty societies relevant to a specific disease and clinical condition, government agencies and other national expert panels.