UnitedHealthcareOnline Evaluating and Improving the Quality and Cost of Care

UnitedHealthcare has created clinical programs to evaluate and improve the quality and cost of care in the areas of:

Cancer – Oncology

Our Oncology programs seek to increase quality and patient safety by increasing compliance with evidence-based standards of care.
Our programs include:

Erythropoietin (EPO) Drug Policy
Herceptin Drug Policy/HER2 Testing (Human Epidermal Growth Factor Receptor 2)
UnitedHealthcare Premium® Designation Program for Oncology
UnitedHealthcare’s Cancer Support Program


The goal of UnitedHealthcare’s cardiac care programs is to improve the quality of cardiac care by providing actionable information to physicians and facilities. We believe that consistently delivered, quality care, results in better patient outcomes and greater affordability for the patient, payer and employer. Our programs are designed to connect consumers with quality, cost-efficient primary, specialty and hospital-based care that is right for them. To accomplish this, we engage physicians, hospitals and employers by delivering data that are specific to patient condition and geographic area.

The cardiac care program is designed to:
Improve the quality of care
Engage and inform consumers
Maximize affordability of care
Cardiac Programs
Coronary Artery Disease (CAD)
Heart Failure
Imaging Accreditation
Physician & Hospital Data Sharing
UnitedHealth Premium designation program – Cardiologists and Cardiovascular Surgeons
UnitedHealth Premium designation program – Specialty Centers

Care Management

Our care management model continues to evolve to incorporate “best national practice guidelines”. By utilizing guidelines, data reports and other evidence-based tools, we provide a framework to help physicians practice consistent and effective medicine. We believe quality and cost of care can be improved if the right care is delivered in the right place, at the right time.

This evolution represents an integrated end-to-end care management program which includes:
Ongoing evaluation of best practices
Results driven decision making
Application of evidence based medicine (EBM) with systematic feedback to physicians and hospitals
Specific Components include:

Advance notification by physicians (outpatient and inpatient services)*
Admission notification by hospitals (inpatient admissions)*
Pre-admission counseling, referrals to Centers of Excellence (COE), dynamic discharge planning
Focused disease and case management
Targeted review by on-site and telephonic clinical teams
Monitoring for timely execution of physician orders in an inpatient setting
Assessment of appropriate levels of care

Neuroscience, Orthopaedic & Spine

The Neuroscience, Orthopaedic & Spine (NOS) program is designed to promote quality through a comprehensive approach to neuroscience, orthopaedics and spine care and engage physicians, consumers and employers.

Neuroscience conditions are experiencing an increase in aggressive treatments, including
carotid artery stents, implantable pumps and deep brain stimulators.
Orthopaedics conditions, including total joints, are experiencing an increase in demand
given changing demographics. People are staying active longer, which is resulting in more
orthopaedic injuries and arthritis.

Spine conditions are the leading cause of adult disability and low back pain is one of the
leading causes of increased health care costs.

Select from the topics in the left navigation for more information on NOS programs and initiatives, including the new Physical Medicine & Rehabilitation Services Notification Program for Colorado and Florida.

Primary Care and Emergency Room Care Management


In collaboration with clinical societies and practice groups, we are seeking to improve the quality, safety and appropriate utilization of imaging services.
The Radiology program features two elements:

Imaging Accreditation
Radiology Notification

Women’s Health