IMPORTANT: Keep Your Provider Directory Information Current to Protect Your Network Status. Learn more
Highmark’s True Performance value-based reimbursement (VBR) program for PCPs continues to grow as it nears completion of its second full year in operation.
Already one of the largest PCP-based private VBR programs in the country, True Performance has seen eligible PCP participation increase to 85%. This includes 7,950 participating physicians from 578 entities in the service areas of Highmark and its affiliated health plans.
Thanks to the hard work and dedication of True Performance-participating PCPs, the program’s impact on the affordability and quality of health care for Highmark members also continues to build, said Charles DeShazer, MD, senior vice president and chief medical officer, Highmark Health Plan. Through June 2018 of the current measurement year, True Performance has achieved more than $153 million in avoided health costs, driven by significantly lower rates of Emergency Department (ED) utilization and inpatient admissions, according to Dr. DeShazer.
So far in 2018, True Performance providers' ED utilization rates are 10% lower than those of providers not in the program, with potentially avoided costs of $21 million. Inpatient admission rates are 17% lower for True Performance providers compared to providers not in the program, with potentially avoided costs of $132 million.
When combined with 2017 results, the program has achieved a total of $415 million in avoided costs to date — $59 million for ED utilization and $356 million for inpatient admissions.
“PCPs have the most insight into a patient’s total health picture and have the greatest opportunity to properly manage chronic illness — which can help avoid the need for emergency medical treatment or hospital admissions,” Dr. DeShazer notes.
True Performance PCPs get data tools and support from Highmark that can enhance their ability to proactively identify potential gaps in care and help ensure patients with chronic illness are properly addressing their health care needs. That support, and the opportunity to be rewarded for providing high-quality and high-value care, continues to attract primary care practices to the program.
Mon Health Medical Center in Morgantown, WV, joined True Performance in 2018. The structure of True Performance has helped their various PCP clinics streamline processes, share ideas, and implement best practices at all locations, said Sam Cilento, decision support analyst in the Quality Department at Mon Health.
“Our PCPs now are even more engaged with their patients in helping them meet expectations of care and manage their health better throughout the year,” Mr. Cilento added.
In addition to helping enhance patient care, True Performance has meant stability for Neal M. Davis, DO, in Carbondale, PA. “The incentive revenue I am earning through True Performance has helped me remain independent, which is very important to me,” said Dr. Davis, who joined the program in 2017.
Another participant in the program since 2017, Sistersville Rural Health Clinic in Sistersville, WV, has found great value in True Performance, both in terms of quality care and resources for their quality initiatives, said Trisha O’Neil, director of QI/PI at Sistersville. “True Performance helps us in our quest to ensure the highest quality of care possible for our patients,” Ms. O’Neil said.
Sistersville has used its True Performance incentive revenue to help fund additional staffing for the collection of quality data, proactive patient outreach, and contacting other facilities and providers for follow-up regarding outpatient services, such as colonoscopies, Ms. O’Neil added. “We also use the incentive funds to support in-house education programs for our providers,” she said.
Somerset Family Practice in Somerset, PA, has been in True Performance since 2017. The program's monthly data feeds make it easier to monitor patients of all ages, said Kassie Smith, RN, Clinical Care Coordinator at Somerset. “I can run a complete report to include all measures for pediatric, adult commercial, and Medicare patients all at one time,” she explained.
The program’s monthly care coordination reimbursement also provides regular revenue for ongoing care management and patient outreach, Ms. Smith added.
E. A. Hawse Health Center in Baker, WV, joined True Performance in 2017. The practice staff like the easy access the program gives them to Highmark data and the support that allows them to enhance patient care, said Linda Lutz, QA/QI and compliance director at E.A. Hawse. “We use the True Performance reports as quality indicators for our practice, and care gap reports are always at our fingertips through NaviNet®,” she noted.
Watch Provider News for updates on how True Performance is supporting and empowering PCPs to improve care quality while lowering costs for Highmark members.
