Highmark to expand patient-centered medical home efforts to improve care and health outcomes for members

Jan 23, 2013, 09:45 ET from Highmark Inc.

PITTSBURGH, Jan. 23, 2013 /PRNewswire/ -- Based on the success of its one-year pilot program, Highmark Inc. announced today that it is expanding its patient-centered medical home (PCMH) initiative to include nearly 1,050 primary care doctors in more than 100 physician practices that cover about 171,000 Highmark members in Western and Central Pennsylvania and West Virginia. The original program, initiated in 2011, included 160 primary care doctors in 12 practices that cover about 45,000 members.

"We demonstrated a number of positive outcomes from the pilot practices, including lowering per member per month overall cost. Specifically, in the pilot, we saw a nearly 2 percent reduction in cost, while the rest of the membership actually saw an increase," said Michael Fiaschetti, president of health markets at Highmark. "Our overriding goal is to work with physicians to improve the quality of the patient experience and overall outcome for the member. Several of our measures showed that we are doing that, so now we are expanding to include more physicians and significantly more members."

Other important findings that Highmark learned from the pilot program included:

  • Inpatient acute admissions dropped on average for the pilot practices by 9 percent
  • 30-day readmission rate dropped on average for the pilot practices by 13 percent
  • 7-day readmission rate dropped on average for the pilot practices by 14 percent
  • There was 5 percent decrease in total per member per month costs for coronary artery disease members and a 3.5 percent decrease for diabetics during the pilot

Through a patient-centered medical home, physicians take greater accountability in coordinating the care for patients. This accountability means assisting patients and their families with treatment and treatment options. It also means better patient education and better use of tools such as electronic health records.

"There is more health care information being exchanged between clinicians. We saw other changes including fewer dollars spent on in-patient care and more on out-patient care. We want to shift people away from emergency rooms and get the chronically ill into regular, more routine interactions with their doctors," said Paul Kaplan, M.D., senior vice president of provider strategy and integration at Highmark.

Under this model, the payment system is also beginning to change with physician practices and Highmark having risk involved. If there are not cost savings, there are not enhanced payments to physicians. Highmark is focused more on paying for value rather than just paying for the volume of services that have been performed. During the next three years, Highmark hopes to have about 75 percent of members in some kind of pay-for-value arrangement by 2015.

SOURCE Highmark Inc.