Highmark, which is among the largest Blue Cross and Blue Shield-affiliates in the country, launched a value-based program in 2017 that saved $260 million in healthcare costs, according to the insurer.
The True Performance program resulted in 11 percent fewer emergency room visits and a 16 percent decrease in inpatient admissions for the year. This resulted in savings of $38 million and $224 million respectively, according to Pittsburgh, Pennsylvania-based Highmark.
Highmark's value-based program is geared towards giving primary care physicians the tools, data and personalized support they need to engage in patient care coordination and population health management.
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Physicians are evaluated on their performance on quality and cost utilization, on meeting nationally-recognized quality measures, such as ensuring members receive appropriate screenings and vaccinations, and in how they help members manage chronic illnesses such as diabetes, heart disease and asthma.
They are rewarded through care coordination reimbursements.
"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," said Charles DeShazer, MD, senior vice president and chief medical officer, Highmark Health Plan. "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."