Despite CMA concerns, United moves forward with Premium Designation program July 1, 2014 Managed Care Managed Care, United Healthcare, Insurance/Reimbursement 0 Sidestepping concerns voiced by the California Medical Association (CMA), United Healthcare is proceeding with the rollout of its "Premium Designation" physician performance program in California. Physicians who wish to request a reconsideration of their Premium Designation status before the results are displayed publicly in the insurers’ network directory on August 6, must do so no later than July 16. CMA had urged United Healthcare to delay implementation for a minimum of six months to allow time for the insurer to address deficiencies with the program and to allow physicians the opportunity to familiarize themselves with the initiative. The program uses clinical information from health care claims to evaluate physicians against various quality and cost-efficiency benchmarks. According to United, the initial analysis period will consist of a historical review of claims data from 2011 and 2012. While CMA recognizes that the necessary data analysis cannot be accomplished in real time, we expressed concern in a letter United Healthcare that a designation based on data that is more than a year old, without the ability for physicians to alter their designation until 2015, will only lead to confusion among patients and physicians and fails to achieve a central goal of the program – which is to modify physician practice patterns to improve both quality and cost-effectiveness. CMA, instead, recommended that United Healthcare utilize the initial report as an educational tool to alert physicians to their historical practice patterns and as a measure to improve physician quality and cost-effectiveness in a prospective manner, among other things. However, United Healthcare has responded it is standing by its Premium Designation program in its current form, citing its longstanding history (established in 2005) and previous incorporation in 41 other states across the country as a basis for moving forward with implementation. For more information on CMA’s concerns with the program, click here. The first United Premium designation letters and results were mailed to over 25,000 physicians on June 5, 2014, with the results to be publicly displayed in the insurer's network directory on August 6, 2014. A second round of assessments will be distributed in fall 2014 with publication set for early January 2015. Since the Premium Designation notices were sent out, CMA has received calls from physicians who confirmed CMA’s concerns and also identified additional issues. Specifically, physicians have reported difficulties understanding the Premium Physician Assessment reports and accompanying data summaries. Physicians have also cited difficulties in submitting online reconsideration requests and an inability to speak with a representative who can provide feedback on ways to improve performance and meet the program benchmarks. CMA is reviewing the response from United Healthcare and is evaluating potential next steps. Physicians who wish to request a reconsideration of their Premium Designation status before the results are displayed publicly in the insurers’ network directory on August 6, must do so by July 16. Reconsideration requests must be filed online through the United Healthcare website at www.unitedhealthcareonline.com (select “UnitedHealth Premium” at the top right, select “Premium Reconsideration” in the left margin). Physicians who encounter problems submitting a reconsideration request can contact United Healthcare at (866) 270-5588. Practices who are unable to resolve the issue with United Healthcare directly should contact CMA at (888) 401-5911 or mlane@cmanet.org. For more information on the Premium Designation Program, visit the United Healthcare website at www.unitedhealthcareonline.com. Contact: CMA reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org. Comments are closed.
