The Premera Premier Provider program evaluates provider quality and episodic cost-efficiency performance on contracted physicians, physician assistants, and nurse practitioners across 12 specialties, including primary care and pediatrics. The program uses methodology consistent with national and industry
standards to measure and identify high-performance providers. The primary goal is to give our members transparency in making well-informed healthcare choices.
Our Premera Premier Provider program aims to:
Providers may receive a high-performance designation if they meet the following requirements:
The program evaluates providers in 12 specialty areas. A provider can only be assigned to one specialty. The specialty types evaluated account for more than 60% of healthcare spend in the commercial line of business (based on Premera claims data).
The quality measurement performance approach is anchored in evidence-based medicine and procedure outcomes. Quality measures selected for Premera Premier Providers are based on:
These measures cover hundreds of conditions and surgical procedures and several areas of quality including:
Cost-efficiency performance focuses on episode treatment costs. Providers are evaluated for their cost-efficiency using industry-standard Episode Treatment Groups (ETGs) methodology. This determines the average cost of treating an episode of care for
each of the reviewed medical conditions and surgical procedures. The program compares episodic cost to those of other providers of the same specialty in the same geographical market to create a cost-efficiency performance measurement.
For more information about the Premier Provider program, please contact your Premera provider network executive(s).