General News
Published August 23, 2021
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.
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.
Premier Provider Program
Through the new Premier Provider program, Premera is focusing 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. The program evaluates provider performance
on contracted providers across 12 specialties, including primary care and pediatrics.
To help members navigate and recognize high-performing providers, the Premier Provider program names providers as either high quality, cost efficient, or both. These high-performance designations are shown on the Premera member-facing provider
search tools and are used by Premera in its service model to customers.
If a provider is designated, an indicator is displayed next to the provider's information. provider performance designations will be updated on an annual basis.
Here is a breakdown of the designations:
- High-Performance Designated Provider
Provider excels compared to their peers in both quality and cost-efficiency standards.
- Quality Designated Provider
Provider exceeds quality standards compared to their peers, but doesn't meet full requirements to be designated as cost efficient.
- Cost-Efficiency Designated Provider
Provider exceeds cost-efficiency standards compared to their peers, but doesn't meet full requirements to be designated in quality.
- Not Designated/Evaluated
Provider doesn't have enough data to be evaluated or doesn't meet quality and/or cost standards. The fact that a provider isn't designated does not mean they don't provide quality and cost-effective care. All in-network providers meet minimum quality standards laid out by the Blue Cross Blue Shield Association.
The Premier Provider program will not impact customer rates. Members will continue to be able 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.
For more details on the program, visit the program webpage. Here you'll find an overview of the program, frequently asked questions, and the full program methodology whitepaper.