November 04, 2014
United Healthcare recently sent California physicians their latest Premium Designation assessment results. These latest results will be released publicly via the payor's online physician directory beginning January 1, 2015.
Physicians within the designated 27 specialty areas, including ear, nose and throat (ENT) and gastroenterology (new for 2015), will again be ranked by UHC on both national and specialty-specific measures for quality and various cost-efficiency benchmarks. Physicians meeting or exceeding these benchmarks will receive a Premium Designation notation on their physician profiles, marketed to UHC enrollees through the payor’s online physician directory. In addition, employers may choose to offer health benefit programs (e.g., reduced cost-sharing or tiered benefit programs) that offer benefit incentives, such as lower copays or coinsurance, for members that use physicians with the United Healthcare Premium Designation.
According to United Healthcare, the latest assessment, released on November 3, is based on claims data from January 1, 2011, through February 28, 2014. the California Medical Association (CMA) has repeatedly voiced concerns about the fact that United Healthcare is basing its current physician designations on data that is more than a year old and for failing to adequately address those physicians who have modified their practice patterns since their last Premium Designation assessment.
While UHC has stated that a central goal of the program is to modify physician practice patterns to reduce cost and improve quality, the insurer has verbally acknowledged to CMA that it will likely take two years before a change in practice pattern is reflected on a physician’s assessment and the doctor is able to achieve a favorable Premium Designation status.
Additionally, UHC markets benefit tiered health plans to employer groups that incentivizes members to obtain care from select providers recognized for providing quality and cost-efficient care, also known as Premium Tier 1. Because the benefit to members who select Tier 1 providers is lower co-pays and co-insurance amounts, the impact of use of the stale data is significant to members as well.
Although UHC indicates that physicians who dispute their assessment results may submit a request for reconsideration until mid-year 2015, a physician wishing to alter public display of their November 3 assessment results prior to public distribution in January 2015 must submit reconsideration no later than 30 days from the date UHC notifies the physician of his or her results.
CMA successfully advocated for UHC to alter its notification letters to proactively inform physicians about the availability to speak to a market medical director upon request regarding their assessment results. Further, UHC also committed to providing additional educational resources and educational webinars on the Premium Designation program. While these changes are viewed as a step in the right direction, UHC has regrettably chosen not to make any of the substantive changes to the Premium Designation program recommended by CMA.
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 the issue with United Healthcare directly should contact CMA.
United hosting webinars on Premium Designation program
At CMA's request, United Healthcare is inviting physicians and practice administrators to attend a special webinar presentation about its Premium Designation program in California. The webinars will be offered in mid-November and will provide an overview on the background and methodologies of the Premium Designation program and allow physicians an opportunity to ask specific questions they may have.
The webinars will take place on the following dates and times. Participants will need to register with United Healthcare prior to attending. Click the registration links below for more information.
For more information about the Premium Designation program, visit the United Healthcare website at www.unitedhealthcareonline.com.