Know Where You Stand with Our PCOR, PCMH and PCPi Reports
UnitedHealthcare is committed to providing physicians with actionable, patient-specific information that will help them deliver the best possible clinical care while empowering them to meet personal and professional goals through our Physician Performance Based Compensation Program (PPBC).
This program includes the Patient Care Opportunity Reports (PCOR), the Patient-Centered Medical Home Program (PCMH) and the Primary Care Physician Incentive Program (PCPi).
The Patient Care Opportunity Report (PCOR) provides clear and actionable information for physician groups and organizations to use to identify their patients’ adherence to preventive screenings, treatments and medications.
Medicare Advantage PCOR
The UnitedHealthcare Medicare Advantage PCOR shows which of our members are due for preventive care including screenings, well care visits or other exams. The information is based on claims and pharmacy records, and can help you close care opportunities, including those related to pharmacy compliance, tied to Healthcare Effectiveness and Data Information Set® (HEDIS) measures and Centers for Medicare & Medicaid Services (CMS) guidelines.
Commercial or Exchange PCOR
The UnitedHealthcare Commercial PCOR identifies Commercial or Exchange members with open care opportunities for preventive screenings, immunizations or other health care services. The opportunities are in line with HEDIS performance measures, and closing them can help you achieve positive health outcomes for your patients. The report is based on claims data and electronic medical record documentation from our members' health care providers.
Community Plan PCOR
The Community Plan PCOR also uses claims data and electronic medical record documentation from our members' health care providers to identify open care opportunities related to preventive screenings, immunizations and other health care services. The opportunities are aligned with HEDIS and can help you meet quality care standards.
First Time Accessing a PCOR Report?
If this is your first time accessing your report, please use your PIN to log in. If you don’t know your PIN, please contact your UnitedHealthcare Network Account Manager or your Provider Advocate.
You can also call our Health Care Measurement Resource Center at 866-270-5588.
The same PIN works for the Medicare Advantage and Commercial and Exchange reports.
The Patient-Centered Medical Home Program (PCMH) is one of the UnitedHealthcare performance based contracting programs offered in specific markets. The PCMH program provides enhanced payments for primary care providers that implement the medical home model of care.
The UnitedHealthcare medical home model of care focuses on several key elements to help reduce medical cost, improve quality of care and provide the patient a better experience with the provider and the provider's practice care management team.
Examples of key elements include better access to care, coordination across the continuum and transitions of care, chronic case management when needed, preventive care, and medication review.
The Commercial Plan Primary Care Professional Incentive (PCPi) program offers care providers an opportunity to earn bonuses for encouraging their patients who are UnitedHealthcare Commercial members to take an active role in their preventive care and choose treatment options with lower out-of-pocket costs.
In 2017 the PCPi Program will be offered to a limited number of practices in Arkansas, Florida, Georgia, Missouri, and Texas. In 2018, we plan to review additional practices and markets for inclusion in the program.
PCPi Program Management Report
To help you achieve your target measures and earn a bonus payment, we created a management report of your performance in the program related to cost-efficiency and quality metrics. You will be asked to enter the PIN provided to you at the start of the program. If you need this PIN please send an e-mail to PCPi_EI@UHC.com.
Patient-Centered Primary Care Collaborative (PCPCC) is a great resource for finding both general information about the principles and value of the medical home as well as specific guides for different stakeholders.
National Committee for Quality Assurance (NCQA) is a resource for recognition programs including a program for medical home recognition.
Need Help with Your Reports?
If you have any questions about the UnitedHealthcare Physician Performance Based Compensation program or need additional information or assistance in accessing reports, please contact your Network Management Contract Representative or Provider Advocate.
You can also call the Health Care Measurement Resource Center at 866-270-5588 for assistance with questions regarding report access or site registration. Representatives are available Monday - Friday, 8 a.m. - 5 p.m. (CST).