Highmark's medical home boosts patient care


Through its patient-centered medical home (PCMH), Highmark has been able to improve patient care, including lowering emergency room and prescription drug use, according to data released by the Pittsburgh-based insurer.

Highmark's medical home, which has been operating for two years and has more than one million participants, motivates providers to assume greater accountability for coordinating care for their patients by helping them with treatment options and decision-making. The insurer noted that its PCMH also has led to more patient education and sharing of data, including focusing on population health, boosting quality and tempering costs.

"We continue to be very encouraged by the results from our patient-centered medical home program," Paul Kaplan, Highmark's senior vice president of provider strategy and integration, said in a statement. "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."

Based on data from more than 152,000 members, Highmark determined that its medical home has improved quality and efficiency of care. In particular, the PCMH:

  • lowered emergency room utilization by about 16 percent for adult care, 14 percent for Medicare Advantage and 13 percent for pediatric care
  • reduced inpatient surgical utilization by 12 percent for adult care and 9 percent for Medicare Advantage
  • decreased inpatient medical utilization for Medicare Advantage members by 25 percent, and
  • lowered prescription drug use by 7 percent

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

Other insurers have seen similar success with their medical homes, particularly when they implement certain foundational factors, including strong leadership and staff commitment to the care model, adequate information technology and effective patient engagement tools. For example, Independence Blue Cross in Philadelphia decreased emergency room use by up to 8 percent, while its members with chronic diseases saw an even greater reduction of up to 12 percent, FierceHealthPayer previously reported.

To learn more:
- read the Highmark statement

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