For too long, the health care industry has focused on quantity of care instead of quality. In the traditional fee-for-service model, doctors and hospitals get paid for the number of visits and tests they order — regardless of patient outcomes. This puts the emphasis on the volume of care, rather than quality and cost.
The result? Health care costs are rising at twice the rate of inflation. So while you and your employees are paying more than ever for health care, patient outcomes aren’t necessarily improving.
A new way forward
Enter value-based reimbursement, a new kind of payment model that changes doctor and hospital behavior by rewarding them based on patient outcomes and total cost of care, not volume. So you get more value for your health care dollar.
Shifting the focus to value
Value-based reimbursement represents a real opportunity to help curb rising health care costs. It’s all about rewarding the right care given at the right time. By giving employees access to higher quality care at lower costs your employees can be healthier.
Centers for Medicare & Medicaid Services has rolled out a number of voluntary and mandatory value-based reimbursement programs. This is just one of many examples showing how value-based programs are transforming the health care landscape.
Making value the focus at Highmark
At Highmark, we believe we’re at the forefront of this change. Because we believe value-based care puts the health care system’s focus where it should be: on member health outcomes.
When member and patient value becomes the center of attention, insurers and doctors team up to find the most cost-effective, quality solutions.
We work with health care providers to establish benchmarks for care, based on national data and best practices. Doctors then demonstrate that they’re meeting or exceeding expectations by providing us with specific performance metrics. As a result, members receive the best coordinated and evidence-based care possible. And doctors are rewarded for the quality of care they deliver.
Our 4 keys to value-based care
The success of a value-based care program isn’t just based on a reimbursement model. Highmark’s strategy is to combine doctor reimbursement, benefit plan design, network design, and population health to drive better member outcomes and help you save.
Introducing True Performance
True Performance, launched in 2017, is Highmark’s foundational value-based reimbursement program. It’s designed to give you a better ROI on your health plan spending by rewarding primary care physicians based on the quality of the care they provide.
To help PCPs improve outcomes for members and make care more affordable, we provide higher incentives when they follow the industry’s best practices. We also provide extra reimbursement to reward them for making sure their patients and our members get the right preventive care to keep them healthy. When doctors make sure their patients and our members get the right care at the right time, this can cut down on unnecessary or preventable costs, like redundant testing, ER visits, or hospital stays.
Date: May 17, 2019