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Premium Designation Program

What is Premium Designation?

When you're looking for a doctor, our Premium Designation Program can help you make informed decisions about the doctors you choose.

The Premium designation makes it easy for you to find doctors who meet national standards for quality and local market benchmarks for cost efficiency.

To find doctors who have been rated for quality and cost-efficient care, simply look for the hearts after their names when you use our
online provider search tool.

Designation Description
Premium Care Physician 
The physician meets the Premium program quality and cost-efficient care criteria.
Quality Care Physician

The physician meets the Premium program quality care criteria but does not meet the program's cost-efficient care criteria or is not evaluated for cost-efficient care.

Not Evaluated Premium Care

The physician's specialty is not evaluated in the Premium program, the physician does not have enough claims data for program evaluation or the physician's program evaluation is in process.             

Does Not Meet Premium Quality Criteria

The physician does not meet the Premium program quality criteria so the physician is not eligible for Premium designation.

How are physicians evaluated?

Quality care evaluation

First, we evaluate the quality of care doctors provide, using independent, nationally recognized standards for treating conditions.

To measure quality, we look at 38 months of a doctor's claims and/or practice data, and compare that to national quality standards for the doctor's specialty. Doctors who meet the national standards are given a quality designation, which appears after their names on our online provider search tool.

Cost-efficient care evaluation

Next, doctors who achieve the quality designation are evaluated for cost efficiency. Cost efficiency doesn’t mean that a doctor’s fees are always lower. It means that the doctor effectively uses health care resources, so you get more for your health care dollar. He or she is more likely, for example, to order the right test at the right time, making sure you get the care you need.

In evaluating for cost efficiency, we compare the doctor with other doctors in their specialty in the same geographic area.

  • We consider the physician's total treatment costs. For example, overall treatment of diabetes versus one specific doctor visit.
  • We compare things such as the use and price of diagnostic testing, prescribed medications, procedures and follow-up care.
  • To make an "apples to apples" comparison, we make adjustments to account for the types of patients the particular doctor treats. For example, if the patients are sicker or their conditions require more care.
Blue hearts doubled

Look for the blue hearts to quickly and easily find doctors who have been recognized for providing quality and cost-efficient care.

 

Premium Specialties

We evaluate doctors in the following 47 credentialed specialties:

Allergy
  • Allergy
  • Allergy and immunology
Cardiology
  • Cardiac diagnostic
  • Cardiology
  • Cardiovascular disease
  • Clinical cardiac electrophysiology
  • Interventional cardiology
  • Ear, nose and throat
    • Laryngology
    • Otolaryngology
    • Otology
    • Pediatric otolaryngology
    • Rhinology
    • Surgery head and neck
    Endocrinology
    • Endocrinology, diabetes, and metabolism
    Family Medicine
    • Family practice
    • General practice
    • Preventive medicine
    Gastroenterology
    • Digestive diseases
    • Endoscopy
    • Gastroenterology
    • Hepatology – liver disease
    General Surgery
    • Colon and rectal surgery
    • Proctology
    • Surgery
    • Surgery abdominal
    Internal Medicine
    • Internal medicine
    • Pediatric internal medicine
Nephrology
  • Nephrology
Neurology
  • Neurology
  • Neurology and psychiatry
  • Neuromuscular disease
Neurosurgery, orthopedics and spine
  • Back and spine surgery
  • Hand surgery
  • Knee surgery
  • Neurological surgery
  • Orthopedic surgery
  • Shoulder surgery
  • Sports medicine
Obstetrics and Gynecology
  • Gynecology
  • Obstetrics
  • Obstetrics and gynecology
Pediatrics
  • Adolescent medicine
  • Pediatrics
  • Pediatric adolescent
Pulmonology
  • Pulmonary medicine
Rheumatology
  • Rheumatology
Urology
  • Urology
Date: 9/16/2019 8:11:26 AM Version: 4.0.30319.42000 Machine Name: PWIM4-CMSWEB01