Highmark health services

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First, the primary focus must be the consumer. Second, a value-based framework must replace old, volume-driven, fee-for-service models. That includes value-based reimbursement — but also prioritizing value creation for the customer.

The first step in overcoming fragmentation in healthcare is an industrywide commitment to defining and measuring value in terms of access, quality, safety, affordability, and the customer experience.

That common starting point makes it easier to see how different stakeholders in the system can better work together to deliver such value.

Third, we must address the cost crisis. Rising healthcare costs are a national problem that constrains employers from hiring; drives up out-of-pocket costs and taxes for individuals; exacerbates disparities in access to quality care; and presents a risk of destabilizing our economy.

Any effort to improve the healthcare system must prioritize cost control. Last, we have to develop better ways to connect different stakeholders within the healthcare system in order to align goals, coordinate efforts, and share data and insights. Highmark Health makes those connections internally through our integrated delivery and financing system in western Pennsylvania, and through affiliated businesses in health information technology, and dental and vision products and services.

The same mindset drives our collaborations with external provider network partners, such as Geisinger Health Systems in central Pennsylvania, and industry innovators like Quartet Health and Axial Healthcare. The goals of this collaboration include:. To promote use of evidence-based treatment pathways, Allegheny Health Network clinicians and Highmark insurance professionals reviewed and unanimously chose a web-based, decision-support tool powered by the National Comprehensive Cancer Network.

We then designed a Medical Oncology Pathways Program that gives clinicians free access to that tool and, among other things, rewards 80 percent or higher use of recommended pathways by removing prior authorization hurdles. It also includes cost information, allowing the medical oncologist and patient to have real-time conversations about treatment costs, where appropriate. Another collaborative success is our Episode of Care Reimbursement Program, designed to remove systemic factors that can contribute to overtreatment, streamline the care experience for everyone involved, and provide physicians with a more predictable revenue stream.

Through this program, we are reducing the use of six-week radiation treatments for breast cancer in cases where evidence shows that a three-week regimen will be just as effective and less toxic. We have a pre-agreed fee — with half paid when treatment begins, half at conclusion — based on appropriate care, not volume of care.

We again remove preauthorization based on compliance with standards. During Year One, this resulted in a 46 percent decrease in average cycle time between treatment and payment. See Exhibit 2. Highmark Inc. From Wikipedia, the free encyclopedia. American Healthcare non-profit. This article is about the health insurance company.

For other uses, see Highmark disambiguation. This article has multiple issues. Please help improve it or discuss these issues on the talk page. Learn how and when to remove these template messages. This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. A major contributor to this article appears to have a close connection with its subject.

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