PITTSBURGH, Pa. — When Highmark launched its True Performance program in January of 2017, the goal was to improve health care quality outcomes for members, reduce annual increases in total health care costs and help physicians engage in patient care coordination and population health management.
True Performance is a value-based reimbursement program for Primary Care Physicians (PCPs) focused on affordability and quality of health for Highmark members. The program evaluates PCPs' ability to deliver the right care at the right time and in the most appropriate setting, and rewards PCPs for their performance on quality and cost/utilization measures.
Highmark's claims data through the end of 2017 is now showing the results of the True Performance program, and they have exceeded expectations.
"PCPs have an enormous influence on our members' health — from routine visits, to prescribing medications to referrals to specialists — and that is why the True Performance program focuses on PCPs," said Dr. Charles DeShazer, senior vice president and chief medical officer, Highmark Health Plan. "And we have seen great success in the first year."
According to Dr. DeShazer, Highmark members who are seeing a PCP in the True Performance program had 11 percent fewer Emergency Room visits in 2017 than members seeing a PCP not in the program.
"True Performance helps physicians focus on prevention and wellness — they are evaluated on meeting nationally-recognized quality measures such as ensuring members receive appropriate screenings and vaccinations," said Dr. DeShazer. "Those prevention and wellness efforts are helping to keep our members out of the ER, and we estimate that potentially avoided costs were over $38 million in just the first year of the True Performance program."
Additionally, members seeing a PCP in the True Performance program had 16 percent fewer inpatient admissions in 2017 compared to members seeing a PCP not in the program – at a potentially avoid cost savings of $224 million.
"True Performance also evaluates physicians on how they help members manage chronic illnesses such as diabetes, heart disease and asthma," added Dr. DeShazer. "When those conditions are properly managed, costly inpatient hospital stays related to chronic illnesses can be avoided."
While costs savings and better health are certainly good for patients and members, PCPs are also seeing benefits from True Performance. Through collaboration with Highmark, they receive the support and information needed to thrive in the new environment of value-based care.
"With True Performance, Highmark provides us with the tools, data, and personalized support we need to better manage our patients' health," said Dr. David H. Shin, an internal medicine specialist in Tarentum, PA. "And when our patients do well, our practice is rewarded through care coordination reimbursements from Highmark that we can reinvest in patient care, so True Performance really is a win-win."
ABOUT HIGHMARK INC.
Highmark Inc. and its health insurance subsidiaries and affiliates collectively are among the ten largest health insurers in the United States and comprise the fourth-largest Blue Cross and Blue Shield-affiliated organization. Highmark Inc. and affiliates operate health insurance plans in Pennsylvania, Delaware and West Virginia that serve 5 million members and hundreds of thousands of additional members through the BlueCard® program. Its diversified businesses serve group customer and individual needs across the United States through dental insurance, vision care and other related businesses. Highmark Inc. is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information, visit www.highmark.com.