Highmark program saves physicians $1B in funding since 2017

Highmark’s True Performance initiative has helped save over $1 billion in avoided hospital costs — like emergency room and admission fees, all while providing and improving patient care since the start of the program in 2017, according to the company.

Sean Burns, vice president of reimbursement at Highmark Inc., described the program as one that “incentivizes physicians to provide high quality care while trying to manage patient costs effectively…to make care affordable for patients while giving them the best care.”

Primary care physicians or doctors who are contracted with Highmark or work at a hospital who is contracted with Highmark and meet the Highmark patient size requirement are eligible to become part of the program.

Once a year, physicians are evaluated and then given incentives through the program if they have provided optimal care and have had a high performance. Incentives such as revenue to fund additional protocols or programs that they would like to put in place to help maintain valuable patient care and end of the year payments are given to physicians who have completed quality work.

“Incentives can cover the cost of programs that manage patients,” Burns added. “They may need to hire a coordinator for a project, or put in protocols to help with patient management. The incentives are designed not only to provide for them, but to provide financial incentives so they can earn more income.”

“A couple of key things that the program does is collectively manage patients costs,” he said. “Managing patients so that they don’t have to go to the ER often or be admitted…that’s where a majority of the savings are coming from. It is not only better financially, but keeping patients out of the ER is a better experience for the patients. It is better all around.”

The goal of this program is to maintain Highmark’s philosophy, to provide “value based care” to patients.

“We are proactively engaging to make sure that they (patients) aren’t getting unneeded care,” Burns continued. “We want to continue to grow and enhance. As an organization we want to look to be better.”

Burns also said that through this program, Highmark is already seeing a decrease in immediate ER visits.

“I get to see the evolution of this program,” Burns said. “I get to interact with physicians and hospitals…the outcomes are fantastic. We can’t be happier.”


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