Highmark BCBS Saves $260M Using Value-Based Reimbursement

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AutoInsuranceMM.Info – Low income insurance – Highmark BCBS Saves $260M Using Value-Based Reimbursement

By Thomas Beaton

– Highmark BlueCross BlueShield has saved $260 million in avoidable care costs by using value-based reimbursement and provider performance standards to hold healthcare organizations accountable for improving beneficiary outcomes.

Highmark’s True Performance Program measures primary care providers (PCPs) on their ability to deliver the right care at the right time within the most appropriate setting. Providers then receive performance-based incentives for their results.

Dr. Charles DeShazer, Senior Vice President and Chief Medical Officer of Highmark Health Plan, said that the True Performance Program has generated both cost reductions and care quality advancements based on an analysis of beneficiary claims in 2017.

“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,” DeShazer said. “And we have seen great success in the first year.”

Highmark plan members visiting PCPs contracted under the True Performance Program had 11 percent fewer ED admissions and 16 percent fewer inpatient admissions than other members. Highmark estimates that reducing inpatient admissions resulted in a spending decrease of nearly $224 million.

“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,” DeShazer added.

“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.”

Providers participating in the True Performance Program are also benefiting from data-driven collaboration with Highmark. The payer provides support and information to help PCPs successfully improve outcomes and earn performance-based financial rewards.

“The real motivation for the program is to improve quality. 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 that contracts with Highmark.

 “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.”