Highmark Inc.'s Patient-Centered Medical Home program shows positive results, improves patient care, reaches milestone 1 million members

PITTSBURGH, Oct. 28, 2014 /PRNewswire/ -- Highmark Inc.'s Patient-Centered Medical Home (PCMH) program, which launched in October 2012, is showing positive results with statistical improvements in patient care, according to company data.

"We continue to be very encouraged by the results from our Patient-Centered Medical Home program," said Paul Kaplan, M.D., Highmark senior vice president of provider strategy and integration. "We are seeing lower patient emergency room use and fewer readmissions. In addition the quality of care across multiple measures has improved. These are leading indicators for cost savings which have been borne out in the program. We believe the program is working well."

Through the PCMH model, physicians take greater accountability in coordinating the care for their patients. This accountability means assisting patients and their families with treatment and treatment options and decision making. It also means improved patient education and better use of tools such as electronic health records. The program has been a catalyst for sharing data, increasing focus on population health, improving quality and controlling costs.

Currently, over one million Highmark members in Pennsylvania, Delaware and West Virginia receive care in the company's PCMH program through the participation of more than 930 medical practices. This figure includes more than 70 percent of Highmark's members in western Pennsylvania and more than 60 percent of its members in central Pennsylvania.

Overall performance of providers who have been in the program for at least one year had a growth rate that was 13 percent lower than the market trend  – meaning that average monthly spending for each Highmark member in that group came in below the expected amount if the members had not been in the program.

Highmark's PCMH data, obtained from a sample of more than 152,000 members in western and central Pennsylvania from physicians completing their second year in the program, implies that the quality and efficiency of care that patients receive has improved significantly since the programs were implemented: 

• Emergency room utilization is lower than the market by about 16 percent (adult care), 14 percent (Medicare Advantage) and 13 percent (pediatric care).
• Readmission rates for commercial and Medicare Advantage members were lower than comparative market rates by 1 and 2 percent, respectively.
• Prescription drug use is nearly 7 percent lower than the market, and stable for adult care, while the market trend is increasing by about 2 percent. Similarly, prescription drug use for Medicare Advantage members is decreasing by nearly 7 percent compared to market, with both the group and the market are trending slightly upwards at about 1.5 percent.
• Inpatient surgical utilization is 12 percent lower (adult care) and 9 percent lower (Medicare Advantage) than the market.
• Inpatient medical utilization for Medicare Advantage members is lower than the market by 25 percent.

"These numbers demonstrate that Highmark's PCMH program is working and that the collaboration between Highmark and health care providers is leading to better care and outcomes for our members," said Kaplan. "We anticipate continued success for our PCMH program going forward."

SOURCE Highmark Inc.

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