At Highmark, we believe to fix healthcare we have to put patients first. To deliver the value-based care that patients deserve, we need to change how health care works. So instead of working with practitioners on one side and us on the other, we’re partnering with you to provide the most appropriate care possible.
Putting patients first means giving members access to high-quality care. It’s about convenience and quality. That’s why we constantly work to identify high-performing providers and offer access to alternative care locations such as clinics, local facilities, and in-home care.
To that end, Highmark has measured a specific set of performance metrics for components of care provided by participating skilled nursing facilities. As a result of that review, Highmark determined that while all participating skilled nursing facilities provide quality care, some providers had higher re-admission rates, higher emergency department utilization and higher than average cost per episode — all of which can lead to higher costs for members.
Effective January 1, 2019, Highmark is creating a new network of skilled nursing facilities to align with the commitment to work with healthcare providers to make sure that our members receive high-quality health care that is affordable.
Beginning Jan. 1, 2019, only those participating skilled nursing facilities that performed at the highest levels will be included in the new SNF network. These providers will also be placed at the highest benefit tier for commercial tiered products using the High Performance SNF Network. Approximately 50% of skilled nursing facilities in Pennsylvania will be included in the network.