United to make some changes to Premium Designation program, but serious concerns remain September 4, 2014 Managed Care Managed Care, Insurance/Reimbursement, United Healthcare 0 United Healthcare (UHC) has agreed, at the urging of the California Medical Association (CMA), to make some changes to its Premium Designation program. However, UHC refused to address many critical problems that CMA had identified, and CMA still believes the program continues to have serious shortcomings. CMA continues to urge UHC to make additional, more meaningful changes with its physician rating and tiering program. "In its current form, the program will not only confuse patients but will also fail to provide them with meaningful information that could actually assist them in making important health care decisions,” wrote CMA President Richard Thorp, M.D., in an August 13, 2014, letter to the insurer. The program uses clinical information from health care claims to evaluate physicians against various quality and cost-efficiency benchmarks. CMA believes that the program as currently planned will only lead to confusion among patients and physicians and fails to achieve a central stated goal of UHC –to modify physician practice patterns to improve both quality and cost-effectiveness. Since the June rollout of the Premium Designation physician assessment reports, doctors have reported numerous problems including (1) the inability to decipher and obtain clarification of the complex assessment reports, (2) insufficient time to thoroughly review and appeal the results of the physician reports, (3) the misattribution of costs related to facilities or other physicians to the assessed physician, and (4) the inability to speak with a UHC representative who could provide feedback on ways to improve performance and meet the program benchmarks for future assessments. CMA in its letter also reiterated its concerns with the ineffective appeal process for physicians who identify errors in the data or who have a high rate of patient non-compliance. CMA believes the appeal process should afford physicians the ability to discuss their concerns with a UHC medical director of the same or similar specialty and that physicians wishing to dispute their status should have a minimum of 60 days to appeal, rather than the 30 days currently allowed. "With the many flaws in the Premium Designation Program that have been identified, CMA is concerned that UHC will needlessly harm physicians and inappropriately steer patients away from quality physicians," Dr. Thorp wrote. Given the significant impact this program could have on a physician practice, CMA also recommended that UHC provide an interactive educational program for physicians and their staff on the background and specifics of the program. CMA recently received notification that UHC will indeed incorporate changes into its notification letters to proactively inform physicians about the availability to speak to a market medical director upon request. UHC has 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 to avoid making any substantive changes to the Premium Designation program. The serious flaws that were ignored by UHC and remain in the program, CMA continues to believe, can cause real damage to physicians and patients, especially as UHC begins to use the inaccurate designations as a basis of steering patients into various tiers. The first UHC Premium Designation letters and results were mailed in early June to over 25,000 physicians with the results 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. CMA had previously urged UHC to delay implementation of the program 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. United Healthcare responded citing the longstanding history of the Premium Designation program (established in 2005) and previous incorporation in 41 other states across the country as a basis for moving forward with implementation as planned in California. Physicians who encounter problems with their physician assessment reports or that 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 at the number below. For more information on the Premium Designation program, visit the United Healthcare website at www.unitedhealthcareonline.com. Contact: CMA's reimbursement helpline, (888) 401-5911 or mlane@cmanet.org. Comments are closed.
