In July, United Healthcare will be rolling out another quality program– separate from its Premium Designation program – called the Healthcare Management Summary Reporting program. Physicians in United’s PPO network will be evaluated on data from 2011 and 2012 patient encounters, with only those physicians meeting the minimum number of episodes of treatment (100 for primary care and 50 for specialists) to be included in the program. Physicians whose practice patterns identify them as potential “outliers” will receive a notice from United along with a copy of their Healthcare Management Summary. The analysis includes evaluation of out-of-network services utilization, antibiotics usage, E&M visit costs, preventative screening adherence and pharmacy-prescribing patterns (i.e, use of brand name vs. low cost pharmaceuticals). Physicians wishing to obtain specific data will be directed to an online web portal to access their individual data utilized in the development of their report.

Although United touts this program as an educational resource “to support physicians by identifying practice patterns that may represent opportunities to improve quality and decrease unwarranted variation in utilization,” the payor has advised CMA that the data for those who continue to rank higher in cost and quality measures will also be considered by its network management staff at the time of physician contract renewal.

United reports that it will re-evaluate physicians at six-, 12- and 18-month intervals to see if there have been changes in practice patterns. Those physicians who demonstrate a 25 percent increase in performance for two consecutive reporting periods will be removed from the monitoring process.

Physicians are encouraged to closely review their individual Healthcare Management Summary report and contact United Healthcare at (877) 282-8608 with any concerns or inaccuracies with the data or specialty classification.