Highmark Showing Reduced Costs and Improved Outcomes With Value-Based Care Programs

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Following extensive research and data review, Highmark Inc. has released new findings showing reduced costs and improved clinical outcomes for members seeing a physician participating in one of Highmark’s Value-Based Care (VBC) programs. 

“Highmark’s VBC programs incentivize physicians to work with us toward common care and cost goals,” said Dr. Philip Majewski, senior medical director for Highmark. “Members have better outcomes by taking their medications, getting recommended screenings and managing chronic diseases while physicians receive higher reimbursements when those care and cost goals are met.”

Highmark also ensures that physicians have the information they need to meet these goals, including insightful tools, custom reporting and personalized field-based support dedicated to value-based programs, Dr. Majewski said.

Some of the areas highlighted in the white paper include:

  • Wellness visits: In three years, nearly 164,000 additional annual wellness visits associated with providers participating in a VBC program have been recorded compared to non-participating providers.
  • Cancer screenings: In three years, more than 154,000 additional cancer screenings were completed by providers participating in a VBC program compared to non-participating providers.
  • Diabetes management:  In three years, nearly 83,000 additional diabetes care gaps were closed by providers participating in a VBC program.
  • Cost management: Since it started in 2017, PCPs in the True Performance program have helped to potentially avoid nearly $2.5 billion in health care costs due to lower rates of emergency care and hospital stays

“We know that preventive care and care management can help reduce health care costs long-term, and can also improve health outcomes for our members,” said Jason Renne, senior vice president of Provider Partnerships and Contracting for Highmark. “That is why we focus on areas such as wellness visits, screenings and chronic disease management with our VBC programs and reimbursement strategies. When physicians also focus on these areas, it can make a real difference for our members.”  

Highmark also has a VBC program for hospitals, known as the Quality Blue Hospital Pay for Value (P4V) program. 

According to Highmark’s white paper, in the past five years, hospitals in the program have amassed approximately $34 million in potentially avoided costs related to emergency care, hospital admissions, and care episodes.

Highmark’s Home Health P4V programs for Skilled Nursing Facilities and Home Health were introduced in 2020 to help members achieve better outcomes and avoid unnecessary hospitalization and emergency department visits after a hospital stay. In two years, these programs have achieved about $12.1 million in avoided costs, based on lower readmission rates.

“I am proud to be part of an organization that is putting so much effort into value-based care,” said Renne. “In putting this white paper together, we have quantified in real numbers the benefits of value-based care and reimbursement for our members and providers.”

About Highmark Inc.

One of America’s leading health insurance organizations and an independent licensee of the Blue Cross Blue Shield Association, Highmark Inc. (the Health Plan) and its affiliated health plans (collectively, the Health Plans) work passionately to deliver high-quality, accessible, understandable, and affordable experiences, outcomes, and solutions to customers. As the fourth-largest overall Blue Cross Blue Shield-affiliated organization, Highmark Inc. and its Blue-branded affiliates proudly cover the insurance needs of approximately 6.8 million members in Pennsylvania, Delaware, New York and West Virginia. Its diversified businesses serve group customer and individual needs across the United States through dental insurance and other related businesses. For more information, visit www.highmark.com.