When you receive your evaluation letter, sign in to UnitedHealthPremium.UHC.com to view Version 12 designation details for physicians or groups in the Premium program. You can download the Premium program Version 12 methodology now to review.
The UnitedHealth Premium program provides physician designations based on quality and cost-efficiency criteria to help members make more informed choices about their medical care.
Physicians may also use these designations when referring patients to other physicians. In markets where tiered benefit plans are available, employers may choose to offer their employees a tiered benefit plan with a lower member cost share for using Premium Care Physicians.
The UnitedHealth Premium reconsideration process allows physicians to request a correction or change to certain quality and/or cost-efficiency information included in their Premium evaluation.
For more information on requesting reconsideration, please click here.
The Premium program consists of both quality and cost-efficiency evaluations. Quality is the primary program measurement and is assessed using national standardized measures. Cost efficiency is evaluated using two measurements: patient total cost and patient episode cost. The physician’s Premium specialty determines which measurement is applied.
The program evaluates 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 evaluation results.
The Premium program first uses clinical quality measures from the National Quality Forum (NQF) - Endorsed measures when available for the specialties being evaluated. The Version 12 Conditions, Measures and Procedures by Premium Specialty page lists the eligible programs for each Premium specialty.
Bridges to Excellence (BTE)
The Bridges to Excellence certification programs measure the quality of care delivered in provider practices. They place a special emphasis on managing patients with chronic conditions who are most at risk of incurring potentially avoidable complications. The Premium program may count individual recognition through a BTE program toward a physician’s quality assessment.
National Commission for Quality Assurance (NCQA)
National Commission for Quality Assurance Clinical Recognition Programs respond to a need for objective ways to demonstrate the quality of care rendered by physicians. NCQA also offers a recognition program for primary care physicians. The Premium program may count individual recognition through an NCQA program toward a physician’s quality assessment.