Value-based Payment Programs Save Money, but is it Passed on to Insurance Customers?

Mike Stankiewicz writes in Fierce Healthcare that Highmark’s value-based payment program saved the insurer more than $260 million within its first year, continuing an industry trend.

Stankiewicz says the nonprofit insurer announced on Tuesday its payment arrangement program for primary care physicians reduced hospital readmissions by 16% last year, which potentially saved $224 million.

The potential savings were generated through claims data from members who saw a physician in the True Performance Program versus those that did not participate. Members that saw physicians int he program had 11% fewer ED visits.

In separate article Jay Green writing for Carin’s Detroit Business notes that hospitals and physicians can do only so much to lower health care costs. It is up to health insurers to pass on those savings to policyholders in the form of lower premiums and cost sharing.

Greene writes that this point was made by Robin Damschroder, CFO of Henry Ford Health System, at last month’s Healthcare Financial Management Association conference in Chicago. She was talking about the use of value-based contracting and the efforts Henry Ford has made over the years to lower per-patient costs.



PITTSBURGH, Pa. (May 4, 2018) — Highmark Inc. has entered into a six-year partnership with Sharecare, the digital health company helping people manage all their health in one place, to exclusively offer innovative, personalized health and wellness solutions to its employer group customers in Pennsylvania, Delaware, and West Virginia. Additionally, beginning January 1, 2019, Highmark members will have access to Sharecare’s personalized mobile and web-based platform that will help them better manage and understand their health, and provide timely and actionable steps to improve it, no matter where they are in their health journey.

“Consumers are more active in their own health care, but they are challenged with credible real-time information to help with health care decisions,” said Dr. Charles DeShazer, senior vice president and chief medical officer for Highmark. “Sharecare is laser focused to meet consumer expectations and ensure an exceptional member experience, and further sets its platform apart with personalized articles, videos and health content from trusted sources like the National Institutes of Health, American Heart Association and Centers for Disease Control — all through the smartphone and in the palm of your hand.”

Sharecare’s real-time data and personalized messages are also beneficial to employers, who are looking for ways to keep employees engaged, healthy and productive. Continue reading

Blues Plans Work to Combat “ZIP Code Effect”

From Health Plan Weekly:

The Blue Cross and Blue Shield Association (BCBSA) recently launched the Blue Cross Blue Shield Institute, a subsidiary of BCBSA created to address social and environmental issues, as evidence mounts that health outcomes may be affected as much or more by social determinants of health as they are by actual medical care.
The Blue Cross Blue Shield Institute says it will address what it calls the “ZIP code effect,” which encompasses transportation, pharmacy, nutrition and fitness deserts in specific neighborhoods. It is partnering with Lyft, Inc., CVS Health Corp. and Walgreens Boots Alliance to address transportation and pharmacy deserts. The institute says it plans to deal with fitness and nutrition deserts in 2019.
Meanwhile, Highmark Inc. will launch a transportation initiative this summer to provide rides for members with chronic health conditions who live in a transportation desert. The service will begin in Pittsburgh as a pilot
On April 17, Highmark’s Allegheny Health Network opened its Health Food Center, which acts as a “food pharmacy” where patients who lack access to food can receive nutritious food items, education on disease-specific diets and additional services for other social challenges they may face.
Other Blues plans also are addressing social determinants of health. For instance, Blue Cross and Blue Shield of North Carolina intends to invest part of its savings from the Tax Cuts and Jobs Act of 2017 into community health programs.
At Independence Blue Cross, the Independence Blue Cross Foundation’s Blue Safety Net Program offers “mobilized services” to medically underserved communities. The IBC Foundation sponsors the Philadelphia Eagles Youth Partnership’s Eagles Eye Mobile to conduct free vision screenings and eye exams and provide prescription glasses to under-insured and uninsured children.
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Hub and Spoke ACOs May be Hard Sell In U.S.

A post today on describes a new alliance in western Pennsylvania between Highmark Health Services and six Allegheny Health Network (AHN) hospitals as being “like an ACO without walls.”

The article, which was reprinted from THE AIS REPORT ON BLUE CROSS AND BLUE SHIELD PLANS, reported that this alliance is part of Highmark’s effort to accelerate the shift from volume-based, fee-for-service (FFS) payment to a system that pays for value.

Highmark describes the alliance, in this article, as a way to foster more integrated care, moving beyond primary care physicians (PCPs) in its Patient-Centered Medical Home (PCMH) program to add specialists and hospitals to the mix. Continue reading

Highmark Expands Closed Network Plans to West Virginia, Delaware

Highmark Health Services on Friday announced it is expanding its closed network product into West Virginia and Delaware in January. Private exchanges, also called defined contribution health insurance plans, allow employers to offer employees a variety of Highmark products within a fixed budget.

Highmark’s private exchange, called MyBenefits, started in 2011. As of July, nearly 80 businesses were using the product, with nearly 6,000 members enrolled, according to the company.

Read the full story at


Top November Posts on the Health Plan Innovation Blog

For the month of November the Top Three posts on the Health Plan Innovation Blog were:

1. Highmark Issues Health Gift Card

2. Yes, we are expensive, but we do poor work

3. Humana Website is a Wiki for Health Care

Continued comments on these and any other posts are always welcome. To receive immediately updated headlines from the Health Innovation Blog, you can grab the blog RSS feed for your reader, or you may syndicate the feed on your Web site.

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