Meeting with NCMS Prompts UnitedHealth Group to Revisit Many Details of Premium Designation Program

Earlier this spring, NCMS heard from numerous physicians and practice managers around the state about problems with United HealthCare’s rollout of its Premium Designation Program, or PDP.  This year notification letters were mailed late, physicians were incorrectly associated with practices, and quality metrics were inappropriately applied, to name a few of the problems.

NCMS presented those complaints to UnitedHealth Group and Premium Designation Program executives.  In response, UHG agreed to reconsider many aspects of the Program in order to make it more user-friendly, accurate, and fair for physicians.  Some of those commitments include:

  • Ensure that initial notification letters are sent timely and that physicians and practices have ample time to file for reconsideration/appeal.
  • Create a state-specific letter that clarifies what, if any, laws or regulations apply to the PDP.
  • Clarify the letter sent to the practice to identify the physicians who did and did not receive designation, and how the practice manager may receive delegation to access the reports.
  • Refrain from posting a physician’s new rating until any pending appeal has been resolved.  Instead, United may leave the physician’s previous rating posted or post a message stating “Rating under appeal.”
  • Faster resolution of administrative errors such as incorrect physicians assigned to the practice, incorrect patients assigned to a physician, incorrect group name, etc.
  • Improved reconsideration worksheets that allow for some reasonable amount of physician notes and documents to be submitted regarding a particular episode.

NCMS is pleased that United was willing to receive physician feedback about the PDP, but also to use the feedback to improve future iterations of the program. Urging managed care companies to improve the fairness and accuracy of their physician profiling programs continues to be one of the Medical Society’s main areas of focus.

 
 

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