Since its inception over ten years ago, UnitedHealthcare regularly evaluates eligible network physicians for inclusion in our UnitedHealth Premium® program. This program evaluates doctors in 16 specialties for quality and cost efficiency. Traditionally, the designations were updated at the end of the calendar year, which meant that the physicians’ status refreshed when most members started their new policy year in January.
This presented a potential disconnect for members in plans that "tier" or provide enhanced benefits if they receive services from a Premium Care Physician. Members in tiered plans who were choosing a primary care physician (PCP) or verifying that certain specialists had the "Tier 1" status during Open Enrollment could find, when the policy year began, that those physicians had lost their Tier 1 status.
Premium Designation Status Timing Moving to September
To address this issue, we are changing the timing of the UnitedHealth Premium designation release to September so that resulting changes to Tier 1 status will be available during the standard fourth quarter Open Enrollment period. For members enrolling in Jan. 1, 2018, benefits, they will be able to view the physician’s Tier status for the upcoming year. These updates are part of our commitment to promote access to quality and affordable health care.
In early 2017, we created a separate Tier 1 symbol for members in tiered plans to help them clearly know where they will receive the highest benefit levels. Additionally, a new two blue hearts symbol was created to show all members if a physician has met Premium’s quality and cost efficiency designation, Premium Care Physician. These symbols are shown below:
For non-accountable care organization (non-ACO) plans, this change will also restore consistency between our Tier 1 and Premium Care Physician designation. In addition, efforts are underway to enhance the methodology to further minimize disruption in the future as we continue to identify physicians for quality, cost efficiency, and value.
For more information, please contact your UnitedHealthcare representative