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How does UnitedHealth Evaluate Physician Performance?

Written By: Jason Shafrin - Nov• 29•12

The UnitedHealth Premium Physician Designation Program assesses the quality and efficiency of physicians’ practice patterns. UnitedHealth uses Quality of care is measured using measures from the NQF and NCQA.  Cost efficiency (i.e., being low cost) is measured using the Symmetry ETG and PEG episodes.
The information generated by this program is used to i) give physicians feedback of their own performance compared to national standards, ii) to inform patients regarding physician quality, iii) for employers and plan sponsors to use a part of value-based purchasing initiatives.

Further description of the program after the jump.

From a recent Health Affairs article by Ellis et al. (2012):

“First deployed in 2005, the program involves nearly 250,000 US physicians and operates in forty-one states. It covers twenty-one different medical specialties— including primary care, cardiology, and orthopedics— which together account for more than 60 percent of the medical spending covered by UnitedHealthcare’s employer plans. Under the Premium Designation program, only those physicianswhomeet or exceed quality benchmarks are subsequently evaluated for efficiency. Quality is assessed using more than 300 measures, including those endorsed by the National Quality Forum and the National Committee for Quality Assurance and others that were developed by medical specialty societies or expert panels and reviewed by committees of practicing physicians.”

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