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Business Highlights: Health Plans

Dr. Neeharika  Muddana, M.D., provides care to a patient

Highmark is collaborating with hospitals, including those in the Allegheny Health Network, to establish patient-centered medical homes. Shown: Dr. Neeharika Muddana, M.D., provides care to a patient at Allegheny General Hospital in Pittsburgh.

New models improve patient outcomes and reduce costs

Building on a longstanding history of collaboration with providers, the health plan business continued to forge ahead with value based reimbursement models that provide better patient experiences, improved health outcomes, better efficiencies and lower health care costs. Two examples include the health plans' Patient-Centered Medical Home (PCMH) pay-for value program and their new Total Health plan.

Launched two years ago, PCMH programs encourage physicians to assume greater accountability in coordinating care for their patients and reward physicians for keeping patients healthy. This means assisting patients and their families with treatment options and decision making, improving patient education and using more advanced tools such as electronic health records. The program has delivered proven, positive results for more than 1 million members in Pennsylvania, Delaware and West Virginia through the participation of more than 840 medical practices.

Said Amy Fahrenkopf, medical director and vice president of market transformation, "Patient-centered medical homes improve patient care and conserve valuable health care resources. Our experience has clearly illustrated that, working together, patients, physicians, practice staff and insurers can increase the quality of care, lower health care costs and improve the overall patient experience."

Extending the success of the PCMH program, the health plans' new Total Health product is an innovative health coverage option that combats rapidly rising health care costs and rewards eligible members who select practices that provide PCMH care. Designed specifically to include only practices that have adopted the PCMH model, Total Health enables members to realize cost savings, along with the host of benefits provided by the PCMH program.