Highmark’s Payer-Provider Integration Shows Benefits

From Health Plan Weekly

Choosing to both sell insurance and operate hospitals might make Highmark Health the "craziest" Blue Cross Blue Shield plan in the country, according to CEO David L. Holmberg, but that also puts it in a better position to transform care relative to organizations that do just one or the other.

The integrated delivery system, which owns the eight-hospital Allegheny Health Network and is building other facilities, has learned that "when you have all the pieces, all the tools together, what you can do is change how you’re delivering care," says Holmberg.

One of the key advantages of being an integrated system is the large amount of data Highmark has access to in the form of electronic medical records and claims. Thus, Highmark is focused on figuring out how to turn that information into predictive data.

Highmark's data also confirms that, as is the case for many health care organizations, a small population drives the majority of costs — largely because of chronic diseases, according to Holmberg.

To address the issue, Highmark took 2,000 Pittsburgh patients with the most complex care needs and partnered with their primary care physicians through a program it calls extended complex care. Over a 12-month period, the initiative reduced that population’s ER visits by 15% and reduced costs by 20%.

Speaking of Highmark's experience operating on the Affordable Care Act exchanges, Holmberg called it a "wild ride." Looking ahead, Holmberg predicted that the road to stability depends on certainty about the rules.

"Tell us what the rules are, tell us where the field is and tell us who the referees are, and I think the marketplace will sort itself out," he said.

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