The Catalyst

The Catalyst

Measuring Our Success…

2018 UnitedHealthcare Cost Results

Results for BHCG employers using UnitedHealthcare’s network in 2018 were recently presented at the BHCG Annual meeting. Some of the highlights include:

  • Employees of BHCG employers that are highly engaged with Premium providers showed a 14 percent lower Per Member Per Month (PMPM) spend, when compared to employees with low utilization of Premium Providers, after adjusting for high cost claimants and claim risk differences[i].
  • Premium Care provider utilization for employers with tiered/incented benefits plans was 43.6 percent, compared to 36.2 percent for those employers without tiered/incented benefit plans.[ii]
  • As a measure of the impact of consumer activation, the risk adjusted PMPM for highly activated employees was $335 compared with $505 for below average activated employees. Consumer activation measures included: wellness visits, use of Premium Providers, evidence-based medicine compliance, clinical engagement and use of consumer tools.

At BHCG’s February Benefits Forum meeting, Dr. Bruce Weiss, vice president of health care strategy at UnitedHealthcare of Wisconsin presented information concerning the UnitedHealth Premium® program that provides physician designations based on quality and cost efficiency criteria. Some highlights include:

  • In the greater Milwaukee and northeast Wisconsin markets, 90 percent of eligible physicians met the quality criteria of the Premium program.
  • On measures concerning Cesarean sections, cardiology stent procedures, hip and knee replacements and lumbar fusions, Premium Care Physicians had significantly lower complications and redo rates.


[i] Dates of Service 1/1/2018-12/31/2018. Excludes Catastrophic Claimants >$100,000 in medical spend, Highly Engaged members have 75% or more of their Premium spend at Premium Tier 1 providers (Quality & Efficient). Low engagement is <75% of the Premium eligible spend. Savings is based on Covered spend (before member cost share) on a per member basis after adjusting for claim risk score

[ii] 2018 is estimated based on existing BHCG customers’ Covered claims incurred and paid through December 2018 with estimated completion, based on BHCG’s historical completion.

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