COVER STORY | LOCAL PROFILE Highmark’s True Performance program reimburses primary care doctors, such as Dr. Judy Wesolowski, based on the value of the care provided rather than the volume.
TRUE PERFORMANCE How Highmark’s Groundbreaking Program Lowers Costs, Rewards Better Care Health-care costs are on the rise. And when employees avoid seeking preventive care because of financial barriers, costs rise even more. They end up resorting to emergency care or require hospitalization, which results in a larger financial burden on employees, employers and the healthcare system. According to the Centers for Disease Control and Prevention, Americans use preventive services at half the recommended rate. And it attributes seven of every 10 deaths to chronic diseases, such as heart disease, cancer and diabetes, accounting for 75 percent of the nation’s health spending.
Highmark Inc., one of America’s leading health insurers, recognizes the need for higher-quality, lower-cost preventive care services for its members. In January 2017, it introduced True Performance, a physician reimbursement program that emphasizes value over the volume of care provided to patients. By rewarding physicians for focusing on preventing and managing conditions before they become serious, True Performance is lowering overall costs.
The Value of True Performance
Within the first year of implementation, the value-based care program for primary care physicians (PCPs) showed remarkable results. In 2017, patients of True Performance providers visited emergency rooms 13.1 percent less than those who receive care from a non-True Performance doctor. They were also admitted to hospitals 16.3 percent less frequently, according to CDC research from January 1 through July 31, 2017. “These results show the impact insurers and providers can make when we collaborate to ensure patients are receiving the right care, at the right time, and in the most appropriate setting,” explains Mari Vandenburgh, director of Value-Based Reimbursement Programs for Highmark. With an emergency department visit averaging $1,123 and a hospital inpatient admission averaging $12,782 in the Highmark affiliate network, the cost savings of decreasing the need for emergency and inpatient care is significant. And employees and employers avoid unnecessary spending, as well.
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FEBRUARY 2018 • mbabizmag.com
Highmark redesigned its physician reimbursement program to help people avoid serious illness and to control rising health-care costs.