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Delegate Performance Management Program, Capitation and/or Delegation Supplement- 2019 UnitedHealthcare Administrative Guide

We conduct an analysis of clinical, quality and health outcomes to identify potential variations in care delivery to support the best quality care and outcomes for our members. By comparing data, that is risk-adjusted when appropriate, identifying variations from peer benchmarks and sharing that information with you, we can work collaboratively to improve value for our members.

Together we get a clearer picture of measures that may provide opportunities for improving quality and care experiences for our members, taking into account standards of care, evidence-based guidelines and Choosing Wisely® recommendations from the American Board of Internal Medicine Foundation, supported through partnerships with more than 70 national medical specialty societies.

Performance Domains
Performance measurement supports practice improvement and provides delegates with access to information regarding how their group compares to peers benchmarks for specific measures. This information provides a starting point for an ongoing dialog regarding how we can best support your efforts in providing high quality, cost-effective care to our members.

Delegate performance domains include, but are not limited to, the following areas of focus:

  • Clinical UM
  • Clinical quality including STARS, HEDIS and member satisfaction
  • Encounter data performance management
  • Credentialing performance management
  • Financial performance management
  • Compliance with UnitedHealthcare, federal and state requirements

Performance domains are evaluated regularly, compared to peers benchmarks, and communicated to the
delegate in the form of performance reports.

Improvement Action Plans
We may require the delegate to develop an improvement action plan designed to bring the delegate into compliance with performance standards.

Delegates who do not achieve compliance within the established timeframes may require continued oversight until they achieve compliance.

Continued non-compliance or failure to perform may result in removing the delegate from the service(s).