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:
- Recognize providers for their quality of care delivered and efficient use of resources. High-performance providers are featured in our products and services to help members find high-quality, cost-efficient care.
- Expand opportunities to share data and insights to help providers improve performance.
- Deliver consistent and reliable performance to improve as a strategic partner of choice for providers.
Providers may receive a high-performance designation if they meet the following requirements:
- Located in the Washington or Alaska markets served by Premera
- Contracted with Premera commercial line of business
- Practicing and board certified within one of the 12 assessed specialties
- Meets minimum volume requirements for completed episodes of care
- Statistically higher-performance on elements of quality and/or cost-efficiency
12 healthcare specialties
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).
- Primary care
- General surgery
- Pulmonary medicine
- Obstetrics and gynecology
The quality measurement performance approach is anchored in evidence-based medicine and procedure outcomes. Quality measures selected for Premera Premier Providers are based on:
- National and industry standards
- Clinical significance
- Existing Premera value-based contracts and products
- Metrics important to local population health priorities
These measures cover hundreds of conditions and surgical procedures and several areas of quality including:
- National standards
- Care patterns
- Medication adherence
- Patient safety
- Disease management
- Inpatient safety indicators
- Inpatient quality
Performance based on treatment costs
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.