United's New Reports Target Physician Outliers

If UnitedHealthcare (UHC) identifies you as an outlier among its physicians, you may receive a new type of report from UHC that details tests, procedures, referrals, and/or billing patterns in your practice that may be inconsistent with certain evidence-based medicine criteria. Initially, UHC is looking at primary care physicians (internal medicine, family practice, and pediatrics), cardiologists, and endocrinologists. It will add other specialists later. 

UHC began sending letters with reports in April to Houston-area physicians. Identified outliers in the rest of Texas will receive letters eight to 10 weeks later. These physicians can expect to receive one or two follow-up reports, as well. 

UHC says the project goal is "not to penalize physicians but drive improvement in behavior and practice patterns." However, failure to improve practice patterns could affect a physician's future participation in UHC programs and products.

Action, May 16, 2014