| Designation is a two-stage process. The first stage is a quality evaluation based on analysis of 24 months of collected claims and/or practice data and adapted to specialty and condition. Physicians who meet or exceed quality criteria, as measured against evidence-based and expert physician approved standards, are designated by a quality star and proceed to an efficiency of care analysis.
Episodes and procedures are then analyzed for efficiency of care adjusted for case mix severity and compared to marekt specialty averages. Physicians who meet or exceed both the quality criteria and efficiency of care criteria are designated with two stars.
UnitedHealthcare identifies designated physicians and hospitals with cardiac services in both online and print physician directories. UnitedHealth Premium designations are identified as the following:
The UnitedHealth Premium Designation program focuses on the quality and efficiency of care performance of physicians and is an informational tool for consumers to guide informed choices about their health care.
Assessment of eligible physicians is based on the comparison of observed practice patterns with the expected practice based on nationally driven evidence and consensus-based measures such as those released by the Ambulatory Care Quality Alliance, the Agency for HealthCare Research and Quality and National Committee for Quality Assurance (NCQA).
Hospitals with cardiac services and physicians that meet or exceed the quality benchmarks receive the Quality designation. Hospitals with cardiac services and physicians that receive the Quality designation then proceed to the assessment for efficiency of care.
Physicians and hospitals with cardiac services that meet or exceed the quality and efficiency benchmarks will receive the Quality and Efficiency of care designation.
UnitedHealthcare makes the one-star “quality” or two-star “quality and efficiency” designations viewable to member through the consumer Web site, myuhc.com. As a result, designated physicians may see an increase in the volume of patients accessing their practice. Physicians also have access to evidence-based information and peer-to-peer comparison data shared by UnitedHealthcare as part of this designation program. Designated physicians performing at the highest levels and who meet defined quality, efficiency and administrative criteria may also be eligible for UnitedHealth Practice RewardsSM, a limited pilot program in 2006, which provides physicians with enhanced reimbursement. The UnitedHealth Premium designation program recognizes specialty and primary care physicians and hospitals with cardiac services that meet or exceed certain evidence and consensus-based quality and efficiency of care standards. The UnitedHealth Premium designation program is:
- For the physician: A resource for practice improvement providing evidence-based guidelines, physician data sharing, and data driven clinical management to reduce variability and enable high quality and affordable outcomes.
- For the consumer: An information tool to guide informed choices about their health care.
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