Participating Highmark Inc. health care providers improved quality performance measures by 26 percent while reducing medical costs by $11.5 million within a six-month period, the downtown Pittsburgh-based health insurer announced Monday.
The results are the first for Highmark’s pay-for-performance programs, which reward doctors for quality of care over number of procedures performed. The programs are part of the insurer’s movement away from volume-based reimbursement for health care providers.
“While the time period is somewhat limited, we think it is important to tell members in our core markets that the trends are very positive,” Mike Fiaschetti, Highmark’s president of health markets, said in a prepared statement. “These numbers demonstrate that the programs are working.”
More than 147,000 members participated in Highmark’s patient-centered medical home and Accountable Care Alliance pay for value care programs for the year ending October 2013. Highmark said it was working “aggressively” to expand the PCMH program in the next year.
Through the two programs, Highmark has more than 540 medical practices, representing more than 3,000 practitioners who care for more than 688,000 members. Both programs reward doctors to provide quality care while holding down costs.
Date: Jan 21, 2014