True Performance Programs

What is True Performance?

True Performance is the foundational program of Highmark's physician value-based reimbursement (VBR) strategy. The program evaluates PCPs’ ability to deliver the right care at the right time and in the most appropriate setting through its intense focus on care coordination and population health management principles. PCPs are rewarded for their performance on quality and cost/utilization metrics and may be eligible to earn monthly care coordination reimbursement and quarterly or annual lump sum reimbursement. PCP entities with 250 or more members are eligible to participate in the program.

Training modules and educational resources are available to help ensure a smooth transition into the True Performance Program. Program participants should log into our provider portal(s) and select Quality Blue to view program documentation and receive program updates.

If you have any questions or need additional assistance, please contact Provider Service.

Available Programs

True Performance Home Health Episodic Bundled Value-Based Payment Program

The True Performance Home Health Episodic Bundled Value-Based Payment Program gives providers the autonomy to administer care to our members with less administrative burden. This advanced value-based reimbursement program is an evolution of the True Performance Home Health Pay-for-Value Program. Providers have the opportunity to earn higher reimbursement amounts based upon quality outcomes. It also incentivizes providers to manage patient episodes, resulting in innovative care techniques to ultimately improve quality and reduced cost. Aligning incentives with providers ensures a material economic interest in the outcomes, resulting in better coordination of the patient experience across the continuum of care. The program will serve as an enhanced value-based reimbursement program for Highmark’s home health provider networks.

True Performance Home Health Pay-For-Value Program

Highmark continues the evolution of our efforts to reinforce and improve quality, enrich our member experience, and reduce the overall cost of care by supporting home health providers with the flexibility to implement innovative care delivery models focused on health outcomes and quality, as well as reduce the operational burden of administrative requirements that do not add value. This True Performance Home Health Pay-for-Value Program will serve as a foundational value-based reimbursement program for Highmark’s home health provider networks. The program offers the potential for significant value-based reimbursement by rewarding participants for managing their Highmark member patient population toward high value, for both quality and efficiency.

True Performance Lite Program

Highmark continues the evolution of our efforts to reinforce and improve quality, enrich our member experience, and reduce the overall cost of care by supporting primary care physicians (PCPs) in coordinating care, managing chronic illness, and providing preventive care. Building on the success of previous pay-for-value programs and incorporating the insights of aligned providers, Highmark True Performance Lite will generate a differentiated experience for PCPs. The program offers the potential for value-based reimbursement by rewarding PCPs and their staff for managing their Highmark patient population toward high value (both quality and efficiency) outcomes of care.

True Performance Physical and Occupational Therapy Pay-For-Value Program

Highmark continues the evolution of our efforts to reinforce and improve quality, enrich our member experience, and reduce the overall cost of care by supporting physical and occupational therapy providers with the flexibility to implement innovative care delivery models focused on health outcomes and quality. Highmark is instituting a Physical Therapy and Occupational Therapy Pay-for-Value (P4V) Program between Highmark and a contracting entity that is a Physical Therapy or Occupational Therapy provider or an entity that owns, employs or contracts with multiple Physical and Occupational Therapy providers. The program will serve as a foundational value-based reimbursement program for Highmark’s Physical and Occupational Therapy provider networks. The program offers the potential for significant value-based reimbursement by rewarding participants for managing their Highmark member patient population toward high value (both quality and efficiency) outcomes of care.

True Performance Skilled Nursing Facility Episodic Value-Based Bundled Payment Program

The True Performance Skilled Nursing Facility Episodic Value-Based Bundled Payment Program gives providers the autonomy to administer care to our members with less administrative burden. This advanced value-based reimbursement program is an evolution of the True Performance Skilled Nursing Facility Pay-for-Value Program. Providers have the opportunity to earn higher reimbursement amounts based upon quality outcomes. It also incentivizes providers to manage patient episodes, resulting in innovative care techniques to ultimately improve quality and reduced cost. Aligning incentives with providers ensures a material economic interest in the outcomes, resulting in better coordination of the patient experience across the continuum of care. The program will serve as an enhanced value-based reimbursement program for Highmark’s skilled nursing facility provider networks.

True Performance Skilled Nursing Facility Pay-For-Value Program

Highmark continues the evolution of our efforts to reinforce and improve quality, enrich our member experience, and reduce the overall cost of care by supporting skilled nursing facility providers with the flexibility to implement innovative care delivery models focused on health outcomes and quality, as well as reduce the operational burden of administrative requirements that do not add value. This True Performance Skilled Nursing Facility Pay-for-Value Program will serve as a foundational value-based reimbursement program for Highmark’s skilled nursing facility provider networks. The program offers the potential for significant value-based reimbursement by rewarding participants for managing their Highmark member patient population toward high value, for both quality and efficiency.

Log into our provider portal(s), then navigate to the Resource Center for all the information, including training and education, on these and other programs.