In early 2017, Highmark launched a new value-based reimbursement program, True Performance, which is focused on affordability and quality of health and positive outcomes for Highmark’s health plan members.

True Performance is a foundational program for Highmark in the movement toward reimbursement for high-quality, cost-effective care rather than volume of care. Rewarding physicians for better patient outcomes instead of the number of patient visits helps better manage members’ premium dollars, and at the same time, improves their care.

Under True Performance, primary care physicians (PCPs) need to meet certain quality and cost measures to earn a reimbursement incentive. They also need to ensure that their patients receive certain preventive and treatment services, such as childhood immunizations, appropriate drug therapy for chronic diseases, cancer screenings, and annual wellness exams — keeping them healthier. This helps members avoid more costly care later. In turn, physicians receive up to a 30-percent increase over what they currently make based on their quality and cost performance.

Another positive aspect of this program for both members and PCPs is a monthly per-patient fee that PCPs receive for care coordination. PCPs invest this money to improve patient convenience, such as offering later appointments or hiring staff members to call and check on patients.

By the end of 2017, data showed that providers in the True Performance program are achieving higher quality and lower cost. In fact, providers in the program have seen lower Emergency Department usage (13.1 percent) for patients versus those not in the program, and lower inpatient utilization (16.3 percent) for patients versus those not in the program. Improvements like this can translate into millions of dollars in care cost savings.