August 11, 2022
Healthcare quality and cost can greatly vary between one provider and another. This contributes to what we refer to as the four problems of healthcare:
- With too much variation, members experience care that costs too much where there should be cost-efficient care.
- They’re not getting what they need when they should be receiving effective care.
- They’re even getting what they don’t need instead of receiving appropriate care.
- And they aren’t having the experience they feel they deserve when they should have an exceptional experience.
Through the Premera Premier Provider program launched in the summer of 2021, Premera has focused on this variation in care for the benefit of the customer by providing objective, transparent, and defensible performance measurement with products and services that navigate customers to high quality and cost-efficient healthcare. This high-performance provider designation program transparently identifies high-performing providers on national and industry adopted standards of quality and cost-efficiency.
High-performance providers, on average, manage a member’s care more efficiently and are more compliant on quality metrics, which can save employers from significant costs and their members from possible medical mistreatment over the course of their care.
To help members navigate and recognize high-performing providers, the Premera Premier Provider program designates providers as either high-quality, cost-efficient, or both. These high-performance designations are featured on Premera’s member-facing provider search tools and used by Premera in its service model to customers. If a provider is designated, the appropriate designation (High Performance, Quality, and/or Cost Efficiency) will display in the provider information available to Premera members (see snapshot below). Provider performance designations are updated on an annual basis.
Beginning August 2022, the Premera Premier Provider designation program will:
- Expand to include physician assistant and nurse practitioner performance
- Extend the review period to calendar years 2019, 2020, and 2021
- Include an updated, robust data set for inpatient and outpatient quality measurement
The Premera Premier Provider program will not impact customer rates. Members can continue to see their current provider(s), regardless of the provider’s designation status. If a provider is still in a member’s plan network, the in-network rate will not
change.
The fact that a provider isn’t designated doesn’t mean they don’t provider quality and cost-effective care. In order to qualify for a designation, providers must have adequate data and must practice within one of the 12 assessed specialties. All in-network
providers meet minimum quality standards laid out by the Blue Cross Blue Shield Association.
The updated program methodology is detailed in the program whitepaper available on the Premera Premier Provider program webpage located on the Provider Home page under the “Special plans,
Networks, Programs” section. The webpage also includes a program summary, FAQs, and contact information.