Unbiased Analysis of Today's Healthcare Issues

How does UnitedHealth Evaluate Physician Performance?

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 […]

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Episode-Based Payment Bundling in Medicare

Bundled payment has been gaining popularity in the minds of policymakers.  In essence, a bundled payment structure gives providers a single lump sum payment to cover all related services for an episode of care.  In the private sector, the Texas Heart Institute and Geisinger Health System both charge a single lump sum for certain procedures. […]

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Episode-Based Performance Measures: A reality?

Pay-for-performance has become very fashionable of late. One way to measure physician performance is with episode groupers. This software groups together some or all of the services related to the care of a patient’s chronic or acute medical conditions. Policymakers can then use the episode as the unit of observation for: feedback on physician performance, […]

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How has episode-based P4P worked in California?

Episodes of care are defined as the bundle of medical treatments used to treat an illness over  a specified time period.  Because all treatments are bundled together, these episodes have been thought to provide a superior unit of analysis in pay-for-performance (P4P) systems.  In fact, Oxford Health Plan pioneered episode payment in the 1990s.  [Later, […]

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