December 03, 2015
Area(s) of Interest: Commercial Payors Payor Issues and Reimbursement Practice Management
United Healthcare (UHC) has announced it will delay the next version of its Premium Designation physician quality and cost assessment program until January 2017. The program uses clinical information from health care claims to evaluate physicians against various quality and cost-efficiency benchmarks.
Originally scheduled to publish its latest results in January 2016, UHC has stated it is delaying in order to allow for improvements to the quality measures and cost-efficiency metrics in response to feedback provided by physicians. This means that the currently posted ratings will remain in place through the end of 2016. Although the California Medical Association (CMA) recognizes that this additional delay may frustrate some physicians, UHC reports it is a necessary delay in order to allow it to make system changes to benefit physicians going forward.
The most recent results were released publicly via UHC's online physician directory on January 1, 2015, and were based on claims data from January 1, 2011, through February 28, 2014.
CCMA had previously voiced concerns about the UHC Premium Designation program citing reliance on data that was more than a year old to determine current physician cost and quality designations and for failing to adequately account for the performance of physicians who have modified their practice patterns since their last Premium Designation assessment.
Premium Designation assessment results are accessible online on the United Healthcare website at www.unitedhealthcareonline.com. Physicians wishing to still dispute their 2015 Premium Designations may do so by submitting an online reconsideration request via the UHC website through July 2016. Physicians who encounter problems with their physician assessment reports or who have concerns regarding their Premium Designation can contact United Healthcare at (866) 270-5588. Practices that are unable to obtain answers to their questions or resolve their issues with United Healthcare directly should contact CMA.