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Highlights: Highmark Health Plans

Collaborating with providers for a first-class member experience

Tom Pellathy, senior vice president of product, network and reimbursement for the Health Plan

Tom Pellathy explains how the Highmark Cancer Collaborative is transforming the cancer patient's experience.

In an ever-changing health care environment, the Health Plan is leading the way in providing superior service and delivery solutions to its members. Through meaningful collaborations, the Health Plan is driving innovation and change by breaking down barriers, aligning care management, making health care simpler, and serving as a trusted partner to its members.

Launched in 2016, the Highmark Cancer Collaborative, a collaboration between the Health Plan, Allegheny Health Network Cancer Institute, and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, is revolutionizing and aligning how cancer treatment decisions are made, how cancer care is delivered, and how cancer care is paid for.

Through a number of interdependent initiatives, including consistent use of best evidence-based treatments, provider reimbursement methods to reward best practices, and removal of administrative barriers that could impact access to care, the Highmark Cancer Collaborative aims to create a replicable model for the creation and dissemination of best practices in cancer care.

"I believe we are unique in how we are integrating these components together, centered around our members," said Tom Pellathy, senior vice president of product, network and reimbursement for the Health Plan. "Above all, we want patients to have confidence that they're getting the best possible care by maximizing their comfort, safety, outcomes, and financial well-being."

Recognizing the importance of simplicity for our members and physicians, the Health Plan is collaborating with several nationally recognized vendors to bring cutting-edge technology and strategic approaches to enhance these relationships. One such collaboration brings new capabilities to better coordinate and integrate physical and mental health care by providing physicians with tools to make quick and appropriate referrals to behavioral health specialists.

"We are retooling the care management program to better identify and resolve clinical, social and behavioral challenges that could be potential barriers to care needed by our members," said Deborah Rice-Johnson, president of the Health Plan.

The Health Plan has also teamed up with a palliative care provider to offer at-home care, which provides an extra layer of support to patients facing serious illnesses and their caregivers. Another collaborative effort focused on opioid usage and pain management gives providers access to information and clinical decision-support tools to help detect, prevent, and reduce opioid abuse and treat dependency more effectively.