Highmark’s value-based reimbursement program saved members $1 billion over 3 years, company says

Ioannis Pashakis//October 8, 2020

Since Highmark Inc. began offering its value-based reimbursement program for primary care physicians in 2017, the Pittsburgh-based insurer says it helped its members avoid more than $1 billion in emergency department visits and hospital admissions.

Highmark officials said its True Performance initiative, a program that rewards physicians for reaching nationally-recognized quality measures, cut costs in its first three years by encouraging providers to focus on quality rather than quantity of care.

“True Performance incentivizes primary-care physicians to deliver the right care at the right time and in the most appropriate setting, and that helps keep customers’ employees and our members healthier, which means fewer ED visits and hospital stays,” said Sean Burns, vice president of provider payment for Highmark.

Incentives for physicians are based on measures such as Highmark members receiving recommended immunizations, appropriate drug therapies for patients with chronic diseases and cancer screenings.

The $1.09 billion amount was based on claims data from 2017 to 2019. About 84% of all eligible primary care physicians in Highmark’s service areas participate in the program, accounting for nearly 11,000 physicians at more than 2,000 practices.

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