In 2015, Highmark Health launched VITAL — a program that provides the missing link between FDA approval of a new medical technology and its reimbursement by commercial insurers. VITAL's overall goal is to make new technologies and services available sooner for patients.
Approved, market-ready innovations often languish while insurers study and test them to decide on coverage decisions. A new medical device can take three to seven years from concept to market. And, new FDA-approved medical technologies can take 15 months to five years before Medicare covers them.
Highmark Health is poised to help drive innovation, discover new interventions, and improve the experience, access, outcomes, and affordability of health care. Effective deployment of new solutions could drive better care at a lower cost.
VITAL serves as a streamlined, test-and-learn engine for bringing new medical technologies, innovations, and services to market more quickly. By coordinating efforts among researchers, data scientists, clinicians, and patients, VITAL collapses traditional barriers to market adoption in an effort to:
Acting as a bridge between innovators and clinicians, VITAL also champions changes in coverage and reimbursement decisions.
Recently, Provider News spoke with Eileen Rodgers, director of the program.
“VITAL brings all of the pieces together — the innovation or procedure, with the clinician, with the patients — so we can gather the data needed to move the idea from investigational to fully reimbursable,” she explains.
When doctors or industry partners identify a potential new treatment, technology, or procedure, VITAL’s support helps them gain insights and collect the needed data to demonstrate the effectiveness of the innovation. VITAL collects the clinical and financial data to make a case for care management and reimbursement policies. And that can give patients faster access to new promising treatments.*
For example, based on data gained from VITAL’s initiative with the LINX® Reflux Management System for gastro-esophageal reflux disease (GERD), Highmark started to cover it in June 2017.
LINX is a circular bracelet of titanium magnets fitted around the base of the esophagus that keeps digestive acids from climbing out of the stomach. Participants reported a positive change in quality of life satisfaction from 8 to 92 percent. And, the treatment resulted in more than 50 percent greater savings than standard invasive surgical procedures.
As of Jan. 1, 2018, Highmark will cover HeartFlow®, a non-invasive diagnostic technology that offers physicians insight into both the extent of a patient's coronary arterial blockage and the impact the blockage has on blood flow. This tool reduced the number of unnecessary invasive coronary angiograms by over 83 percent and saved an estimated $2,844 per patient.
“We’d love to hear from physicians who have an interest in solving any unmet clinical needs. We want to work with innovators who are trying to improve care while making it sustainable," Rodgers adds. "There are plenty of opportunities to work together and prove that clinical transformation works.”
For more information or to begin an application, visit vitalinnovationprogram.org 
or send an email to VITAL@highmarkhealth.org.
*The coverage of any medical service or treatment is subject to the terms of the member's benefit plan.
