New physician designations will feature more claims and quality measures
- Fully Insured and Self-Funded
- All States
UnitedHealthcare will release updated UnitedHealth Premium® program designations in September for eligible network physicians. The updated designations are designed to to enhance the program's goal of promoting access to quality and affordable health care. The key changes to the program include:
- Updated claims data — For September, UnitedHealthcare is using claims data from Jan. 1, 2016 through Feb. 28, 2019.
- Updated quality measures — Specifications for evidence-based quality measures have been updated with new measures such as outpatient complications, hospital readmission and opioid prescribing.
- Enhanced cost efficiency methodology — The cost-efficiency methodology has been updated to give proportional weight to patient and episode costs based on expected costs to treat. This helps to recognize physicians who treat complex conditions more efficiently.
New markets included in this release are New Hampshire, the Upper Peninsula of Michigan and St. Louis, MO.
Note: For members residing in the St. Louis market only, benefit plans that tier benefits based on Premium designations are not available due to contractual limitations. Additionally, Premium designations in St. Louis will be visible on myuhc.com® on Jan. 8, 2020.
Premium Care Physicians represent the 16 specialties and 47 subspecialties that meet program benchmarks for quality and cost efficiency. UnitedHealthcare assesses quality by 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 myuhc.com and mobile applications on Sept. 4.
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 savings opportunity while maintaining stability and access and limiting disruption from the previous release.
For provider directory display, existing Tier 1 physicians will retain their Tier 1 status display through the end of 2019 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 2019.
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.
The UnitedHealth Premium® designation program is a resource for informational purposes only. Designations are displayed in UnitedHealthcare online physician directories at myuhc.com®. You should always visit myuhc.com for the most current information. Premium designations are a guide to choosing a physician and may be used as one of many factors you consider when choosing a physician. If you already have a physician, you may also wish to confer with him or her for advice on selecting other physicians. You should also discuss designations with a physician before choosing him or her. Physician evaluations have a risk of error and should not be the sole basis for selecting a physician. Please visit myuhc.com for detailed program information and methodologies.
Tier 1 providers may be subject to change, visit myuhc.com® for the most current information or call the number on your health plan ID card.