Highlights: Highmark Health

For innovative, early-stage health solutions, FDA approval or clearance is just one step in a long journey. To achieve the ultimate goal — a marketable solution that reaches patients and improves lives — evidence must be compiled to convince health care providers to offer the innovation and health plans to cover it.

That's where Highmark Health's VITAL Innovation Program comes in. Leveraging Highmark Health's unique capabilities as the nation's second-largest integrated care delivery and financing system, VITAL helps gather real-world cost, care, and patient experience data. Along the way, VITAL serves multiple customers: health solution companies, clinicians, health plans and systems, and the individuals who benefit from early access to leading-edge medical devices and treatments.

This includes HeartFlow® Analysis, a non-invasive cardiac test that creates a digital 3D model of a patient's coronary arteries and simulates blood flow to help physicians evaluate the impact of coronary blockages. VITAL's customer wasn't just HeartFlow, Inc., the creator of this solution. It was also Allegheny Health Network (AHN) cardiologists.

"I was interested in using HeartFlow's technology for my patients when it came out, but it would have been difficult to champion adoption on my own," explained Dr. Moneal Shah, the AHN cardiologist who led clinical testing of HeartFlow. "VITAL accelerated the process. Everyone was very collaborative and invested in making sure the testing went well, and we did everything possible to get accurate research data. Using HeartFlow is improving patient safety and reducing cost, helping us avoid more invasive and costly tests like coronary angiograms. In other cases, it has identified abnormalities that didn't turn up in stress tests. It's significant that AHN is offering HeartFlow before anyone else in our region."

The data from VITAL testing was valuable for another important customer: health plans. During 2018, several health plans joined Highmark Health Plans in changing medical policy to cover HeartFlow.

All of which is great news for HeartFlow, Inc. "Getting high-quality clinical data is absolutely critical for a small company that is trying to transform how cardiovascular care is being practiced," said Dr. Campbell Rogers, chief medical officer at HeartFlow, Inc. "The real-world study conducted by Highmark Health's VITAL team and Allegheny Health Network was incredibly rigorous and is playing a critical role in the adoption of HeartFlow."

The HeartFlow story aligns perfectly with Highmark Health's mission, since it is an innovation that helps to avoid unnecessary procedures, improve customer experience, and ultimately reduce the total cost of care. As for VITAL, one of its 2018 success stories was innovating its own business model.

"VITAL was initially an internal platform that funded testing to benefit AHN and Highmark health plans," explains Sarah Ahmad, Highmark Health senior vice president of innovation and transformation strategy. "But the cost evidence, care evidence, and experience evidence our integrated care delivery and financing system provided was so valuable that we discovered that companies would also fund their own testing. So we expanded VITAL to include a commercial offering — we announced our first customers in December. We expect to do 10 or more testing and validation projects per year by 2020."

Dr. Moneal Shah studies the results from the HeartFlow Analysis