Telehealth claims exploded in 2020 for Highmark

Highmark members increased their use of telehealth services by 3,400% last year as a result of the COVID-19 pandemic.

Unable to access their local providers because of quarantine, more patients than ever had access to virtual care in 2020.

Pittsburgh-based Highmark has offered telehealth services to its members for many years, but for a majority of its members, 2020 was their first year that they needed it, said Dr. David Webster, vice president and executive medical director of clinical services at Highmark.

“Overall, by the end of 2020 we saw an increase in utilization of telehealth services by more than 3,400 percent over 2019 and more than 3.4 million telehealth services were accessed by our members,” said Webster.

In 2020, Highmark paid local doctors nearly $300 million for telehealth services, an increase of more than 8,000% over 2019, according to Webster.

Even after stay-at-home orders were lifted across the state, Highmark continued to see patients rely on telehealth to avoid the virus as well as long waiting times for appointments.

Throughout the year, the insurer saw 1.5 million claims for behavioral health services and 1.1 million claims for primary care services. 3.3 million of Highmark’s claims were for local doctors while 79,000 came from telehealth vendors such as Brightheart, American Well and Doctor on Demand.

“Highmark’s data also showed that women were more likely to utilize telehealth, and that members aged 30-39 were the most likely to access telehealth services, with 350 per 1,000 members in this age group utilizing telehealth services,” he said. “We also saw the largest number of telehealth claims among members aged 19 or younger.”

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

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.

COVID-19 fund awards $146,000 in grants to York County nonprofits

Seven York County nonprofits were awarded part of $146,000 in grants through the York County COVID-19 Response Fund.

The fund, created by the York County Community Foundation (YCCF) and United Way of York County, was launched in March and has raised over $1 million and awarded $443,000 in grants to area nonprofits.

Awards are given to nonprofits to help York County residents impacted by the pandemic by providing food and rental assistance.

In the most recent wave of grants, YCCF and United Way of York County awarded:

  • Central Pennsylvania Food Bank
  • York County Food Bank
  • York Benevolent Association
  • Salvation Army of York, PA
  • New Hope Ministries
  • CASA
  • Community Progress Council (CPC)

The Salvation Army, New Hope Ministries, CASA and CPC will continue to provide crisis budgeting and rental assistance to families in need with help from the funds.

CPC, a York nonprofit that works with low- to moderate-income individuals to help them become self-sufficient. will use the money to help it distribute up to $4.4 million in CARES Rent Relief Program funding.

The organization was chosen by York County and the Pennsylvania Housing and Finance Agency to process applications for rent relief through the end of September.

As part of the program, qualified tenants can receive up to $750 per month in rental assistance for up to six months. To qualify, residents must have experienced a 30% or more decrease in income since March 1, 2020.

Coronavirus resources for area employers

Across the web, business associations and governmental organizations are offering vital information for employers as they keep employees and clients safe, manage remote working strategies and maintain their businesses during a nationwide closure.

Employers can use these resources to stay informed about the COVID-19 pandemic.


Pennsylvania Department of Health: For daily counts of confirmed cases in Pennsylvania, press releases and frequently asked questions.

Centers for Disease Control and Prevention (CDC): Information on symptoms, the virus’ effect on older adults and people with medical conditions and how to prepare your family. The page also shows the total number of cases by state.

CDC Travel: Information on high-risk countries, tips on traveling in the U.S. and frequently asked questions for travelers.


The U.S. Small Business Administration: Coronavirus: Small Business Guidance and Loan Resources is the landing page for its Economic Injury Disaster Loan program. You’ll find guidance for small business owners regarding the issues they could come across at this time.

HR Compliance Bulletin:  A release from Harrisburg-based Pennsylvania Chamber Insurance that outlines possible compliance issues for employers.

Coronavirus Workplace Tips for Employees and Guidance for Employers: Two CDC reports on how to respond to the spreading of COVID-19.

The Manufacturers’ Association’s Coronavirus Employer Guide: A guide for manufacturing employers with tips on labor relations, international workforces and workplace safety issues.

The National Restaurant Association: You’ll find a list of actionable information such as handwashing infographics, a food safety blog and a “before you come to work” poster.


PA Chamber of Business and Industry: Coronavirus prevention resources from state and national sources.

Harrisburg Regional Chamber & CREDC: a list of members offering support for other businesses.

Lancaster Chamber of Commerce: A source for legal and economic insight and nonprofit resources.


The Central Penn Business Journal; The Centers for Disease Control and Prevention; CDC Emergency; PA Department of Health; Pa. Secretary of Health Dr. Rachel Levine; Lancaster Chamber; Pennsylvania Chamber; The U.S. Small Business Administration; Pa. Governor Tom Wolf; Harrisburg Chamber of Commerce & CREDC;

Select EMS agencies get more care options under test of new Medicare model

A new Medicare payment model being tested on three midstate EMS agencies will offer more options for caring with patients covered under Medicare

The Centers for Medicare & Medicaid Services (CMS), a federal agency that oversees Medicare and Medicaid programs across the country, announced 205 ambulance care organizations that will participate in its new Emergency Triage, Treat and Transport (ET3) Model late last month.

The model drew 210 applicants nationally and CMS chose 205 applicants from 36 states and the District of Columbia.

The local participants include: Harrisburg-based Community LifeTeam EMS; Camp Hill-based Geisinger Emergency Medical Services, formerly known as West Shore Advanced Life Support Services; and Hershey-based Milton S. Hershey Medical Center.

Currently, Medicare only pays ground-based emergency ambulance services when they transport patients to specific types of facilities, with hospital emergency departments being the most common. The new model, which is set to begin this spring and last over a five-year period, will increase the options that participating organizations have with patients, the department wrote in a press release this week.

“For a patient who calls 911 for emergency medical services, the only path for the EMS agency to receive reimbursement for the call is to transport the patient to the emergency department,” said Paul Christophel, executive director at Geisinger EMS. “If a patient can be treated at home and EMS resolves their issue, the EMS agency does not receive reimbursement”

Participants in the model will continue to receive Medicare payments for transporting the Medicare beneficiary to an emergency department, but they would also be covered if they take that patient to a primary care doctor’s office or urgent care clinic.

CMS doesn’t plan to limit the alternative destinations that the EMS agencies can may use, as long as the treatment is provided by Medicare enrolled providers, a CMS spokesperson said in a statement.

The organization could also receive payments for treating the patient at the scene or through telehealth to connect the patient directly to a physician.

Geisinger EMS already treats its patients at home when appropriate, according to Christophel, but the change in model would allow the EMS agency to receive reimbursement for such treatment.

Delivering the Medicare beneficiary to a primary care doctor where fees are cheaper than an emergency room will save both EMS agencies and their Medicare beneficiaries money, said Scott Buchle, program manager at Penn State Health Life Lion EMS.

Patients with less severe conditions like colds and seasonal flu can still be delivered to an emergency department under the current model—conditions that aren’t always covered by insurances and can incur costs on the EMS and its patients, he said.

Through the new model, EMS agencies will be reimbursed for taking Medicare patients to hospitals, physician practices and urgent and walk-in care centers, said Craig Skurcenski, vice president of emergency medicine at UPMC Pinnacle.

“While this new program authorizes payment for alternative care destinations, our primary goal continues to be proper and appropriate care for all patients,” he said. “This will be ensured by patients having a consultation with a licensed provider prior to determining where a patient will be transported.”

Once CMS outlines the rules for the program, EMS agencies will be able to negotiate agreements with local urgent care centers and prepare to leverage technology such as telehealth in their ambulances, Penn State’s Buchle said. Penn State Health’s Life Lion EMS will be looking at bringing Medicare patients to Penn State Health clinics when that patient has a primary care physician within the system.

“In Dauphin and Lebanon counties, the Life Lion units would be allowed to transport to our University Physician Center clinics if the patient has a primary care provider at one of those locations,” he said. “We can also work with our existing telehealth resources within Penn State Health to help provide the care needed.”

Along with the 205 EMS agencies, CMS said it plans to offer funding for up to 40 two-year cooperative agreements between it and local governments or their 911 call centers in regions where a participating agency practices.

The funding would help a local government or call center afford to put a nurse, nurse practitioner or physician assistant in a 911 center to help direct patients to the right care, said Buchle.

The two-year cooperative agreements are a test to see if call centers and the approved EMS agencies can work together to avoid unnecessary transportation even further than what the new model can provide.

“The model will test whether these new options for emergency services will work synergistically to improve quality and lower costs by reducing avoidable transports to the emergency department and unnecessary hospitalizations following those transports,” the department said in a statement.

New Penn State Health VP to manage staff development at new hospital


Penn State Health’s incoming vice president for medical affairs and staff development is expected to lead in the recruitment of staff for the system’s new Hampden Medical Center when it opens in 2021, according to officials.

Dr. Safa Farzin, former CEO of the Harrisburg-based independent physician association Medical Group of Pennsylvania, will take the position on Dec. 23, Penn State Health announced on Thursday.

Farzin will lead Penn State Health in its relationships with private practice physicians and play a role in the system’s efforts to improve patient access to providers.

The system is currently searching for a president of the new Hampden Township medical center and expects to announce an appointment by early 2020. Farzin will work directly with that new hire to develop the hospital’s staffing model and medical staff by-laws.

“(Farzin’s) rapport and familiarity with the physician community in this region and his work with Medical Group of Pennsylvania make him well-suited to support the continued development of our clinically integrated network in concert with Highmark,” said Dr. Peter Dillon, executive vice president and chief clinical officer of Penn State Health. “Above all, he will bring the important perspective of independent community practice providers to our planning of clinical services on the West Shore.”

Farzin is board-certified in internal and critical care medicine. Prior to working for the Medical Group of Pennsylvania, he was vice president of Pulmonary Critical Care Medical Associates and director of critical care medicine at UPMC Pinnacle Health.