Highmark expands medical home after care costs drop


Highmark is expanding its patient-centered medical home (PCMH) through which it pays participating doctors more money for providing quality care, Pennsylvania's largest insurer said Wednesday.

Although the program means Highmark will initially spend more money, the insurer believes the resulting outcomes, including avoiding hospital readmissions and providing more consistent care, will offset those costs, reported the Pittsburgh Tribune-Review.

Highmark already achieved success with its PCMH pilot project, in which 160 doctors reduced costs for 45,000 members by 2 percent. The insurer is expanding the PCMH to include more than 1,000 primary care doctors and 171,000 members, and hopes to enroll 75 percent of its members in a PCMH by 2015, according to a statement.

Although doctors must assume a certain level of risk to participate in Highmark's PCMH, the company has received almost no pushback from doctors. "What we are doing is re-empowering physicians, handing power back to them," Paul Kaplan, Highmark's senior vice president for provider strategy and integration, told The Patriot-News. "We will have happier patients. We will have happier doctors."

Highmark has been assisting participating doctors to create the necessary infrastructure, including purchasing software and providing short-term staffers, to implement the PCMH. It also shares data with doctors so they can manage illnesses using the most proven and cost-effective treatments.

To learn more:
- here's the Highmark statement
- read the Pittsburgh Tribune-Review article
- see the Patriot-News article

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