Highmark Health, a Pittsburgh, PA-based enterprise that employs more than 42,000 people who serve millions of Americans across the country, is the parent company of Highmark Inc., Allegheny Health Network, and enGen.
Highmark Inc. and its subsidiaries and affiliates provide health insurance to approximately 7 million members in Pennsylvania, West Virginia, Delaware and New York, as well as dental insurance and related health products through a national network of diversified businesses.
Allegheny Health Network is an integrated delivery network comprised of 14 hospitals, more than 2,600 affiliated physicians, ambulatory surgery centers, an employed physician organization, home and community-based health services, a research institute, a group purchasing organization, and health and wellness pavilions in western Pennsylvania. Founded in 2014 as HM Health Solutions (HMHS), enGen is a wholly owned subsidiary of Highmark Health whose dynamic ecosystem of smart automation and technology supports and streamlines complex operations for health plans and their provider partners.
Highmark Health's vision is a world where everyone embraces health. Its mission is to create a remarkable health experience, freeing people to be their best. Through its structure as a blended health organization, it is uniquely positioned to pioneer new models and transform the health care industry to work better now and for generations to come. The financial overview and financial performance information in this annual report demonstrate the financial strength of the enterprise, which allows it to invest to meet the needs of customers and strategically align with health industry innovators and leaders who share its focus on delivering high-quality outcomes and an exceptional customer experience.
Living Health's "digital front door" opens for consumers
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Dr. Anil Singh: The most exciting thing right now is around Living Health, which is really putting payer and provider together to solve the fragmentation that is occurring currently in healthcare. The ability to move things that can be digital to digital to create efficiencies for patients and physicians to make the experience better for both.
Dr. Tony Farah: Doubled down on how we take care of people, but really take care of more of them, knowing all those barriers, whether it's social determinants that are problematic, whether it's lack of affordability, whether it's lack of interoperability, in improving the health of the populations we serve, not just one by one, but really at a much larger scale.
Dr. Anil Singh: I also believe that it started with the fact that Highmark Health took a chance on a provider system, and because of that, they really began to think how do you start to work together in a unique way — that not a lot of other places in the country are doing to really kind of solve and sit down and solve healthcare.
Dr. Tony Farah: We don't want to tell physicians how to practice medicine. What we need to do is reduce the administrative burden and give them the most actionable information without them having to ask for it that allows them to then do what they do best. It has to be that combination between the clinicians and artificial intelligence and analytics.
Dr. Anil Singh: Leveraging our data from the insurance side, coupled that with the clinical data that will eventually be pulled together so that we can then be provided as clinicians that the next best action is the right digital solution that somebody would engage in.
Dr. Tony Farah: Through this digital technology, and through enabling access in ways that weren't available before, more and more of our members and patients now will have access virtually and through apps and other means to be able to see their own results sometimes in real time. So now the patient is self-engaged with their with their health.
Dr. Anil Singh: So one of the ways we’re doing that right now is with a diabetes solution. And what that does is goes back to that predictive and proactive way instead of waiting for somebody to get sick, the app is able to continuously monitor somebody's blood sugar. And so, if on a Tuesday when I'm not seeing that patient, their blood sugar drops, there's an immediate phone call or a tickler if you will, to the patient that says what's going on, a health coach reaches out to that patient and begins to manage that patient right then in there. Now we can interpret the data for the patient and potentially modify behavior. And that is the I think the precipice and the genesis for better health is the ability to be aware of what's actually happening and why maybe a certain behavior is leading to a potentially poor outcome.
Dr. Tony Farah: We do have data that's allowed us to demonstrate that if you take diabetic patients who let's say have a high, we say a A1C level that's a blood test that allows you to see the three month average of you know how your blood sugar is, and we've taken those populations and within three months, brought the majority of those patients A1C levels down to within normal. And that's something that is not easy to do. We know how to do it one by one, but to be able to do this for large populations is pretty amazing.
If you look at the National Medicare data, about one out of four, sometimes one out of three patients have been hospitalized with heart failure within 30 days, come back to the hospital, which is crazy, and it's unacceptable. We've been able to prove through our pilots that you can reduce that to a single digit number. Just doing more of the things we know how to do. So now you start adding the digital and the virtual, analytics, artificial intelligence and the algorithms that allow us to give our clinicians and clinical teams that information and therefore move care upstream.
You can see how those early proof points allow us to do much better by the populations we serve. Same with high blood pressure. We know that we can bring anyone's uncontrolled blood pressure down to normal. We just need to do it at scale. We need to do it for more people.
Dr. Anil Singh: We're building what we call next best actions. And all those things are really kind of the beginnings of the execution of our Living Health strategy and vision.
Dr. Tony Farah: Our goal is to really improve the health of hundreds and thousands more of those members that we serve. And, you know, we're mission base, and I would tell you, it's our responsibility to do this.
Dr. Anil Singh: I'm most proud of being at an organization that really cares about health care and not just the bottom line. I'm most proud that we are working in a blended way by putting payer and provider together and really beginning to solve that problem. That's what keeps me going every day.
Formally announced in December 2020, Highmark Health's Living Health strategy promises to reinvent the health, coverage and care ecosystem to better serve individual and clinical needs. Some of Living Health's early work happened behind the scenes from a consumer perspective, but that changed in 2022.
February 2022 saw the launch of Well360 Diabetes Management by the health plan subsidiaries the first in an expanding suite of digitally enhanced solutions that are part of Living Health's commitment to provide proven, effective support tailored to each individual's health needs.
Well360 Diabetes Management includes a smart glucose monitor, at-home A1C test kit, and unlimited testing strips, along with an app to help turn test results into actionable insights. Just as important, the program includes a care coordinator and personalized health plan, virtual access to health coaches, clinicians, and prescriptions, and coordination with existing primary care physicians.
In a pilot of Well360 Diabetes Management, 92% of participants with a baseline A1C of 9% or greater improved by an average of 2.7 percentage points. In its first year, the program's monthly engagement rate of 63.6% was well above its 50% target reinforcing the belief that simpler, more convenient systemic support can go a long way toward getting individuals more engaged in their health.
Expansion of virtual and digital solutions is occurring across the industry, but it doesn't address a root cause of frustration, subpar outcomes, and unnecessary expense in U.S. health care: fragmentation. That's where Living Health's biggest big idea comes in. In collaboration with Google Cloud and League, Highmark Health is evolving a highly integrated, dynamic platform to connect more of an individual's health experience in one place. Using advanced analytics and artificial intelligence, the platform will also turn data, personal preferences, and care model guidelines into simple, personalized "next best actions" that help individuals and clinicians engage in health proactively, not just after problems arise.
In November 2022, Highmark Health announced a great leap forward in that vision. Beginning in 2023, a phased rollout will give many members of Highmark Health's subsidiary health plans access to a single sign-on app and web platform branded as My Highmark. Depending on a person's health needs and health plan, the new digital health platform will provide a one-stop shop for health coverage and bill payment, care navigation, third-party partner and employer-sponsored programs, prescription services, condition-specific digital and virtual health solutions, data from wearable devices, and more.
"The blended, personalized experience within My Highmark is a milestone in our Living Health strategy to make health care less fragmented and frustrating to navigate, and simpler for members to proactively engage in their health," explained Karen Hanlon, Highmark Health's chief operating officer, in a press release.
Looking ahead, she emphasized that there is much more to come now that Living Health's "digital front door" is open for consumers. "By design, the platform we are building will continuously improve, allowing us to connect legacy systems with new digital and virtual capabilities, map new data sources, and integrate new partners, in ways that weren’t possible before. For the people we serve, that means a more holistic, better coordinated, and more personalized experience. We believe that's the path to better health engagement, which in turn will improve outcomes and lower total costs."
Introducing My Highmark [Video]
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Through My Highmark, our new digital member portal and mobile app, we're making it easier than ever to manage health. My Highmark integrates health, coverage, and care into one platform, so members can find the right tools and resources when and where they need them. With one user name and password, members can access insurance coverage and clear details on cost, virtual care, including specialty practices and chronic condition management, prescription services, and health and wellness programs. Members can even find a provider, or, if they need help, connect with their Member Services team all in one place. With My Highmark, we're proud to support members with a simple, proactive, and personalized path to better health.
$26 billion operating revenue in 2022
In 2022, Highmark Health and its subsidiaries and affiliates made capital investments of $915 million to advance the mission of creating a remarkable health experience, freeing people to be their best.
Insight: Living Health's Integrated Health Experience Platform
"Living Health…means a more holistic, better coordinated, and more personalized experience. We believe that’s the path to better health engagement, which in turn will improve outcomes and lower total costs."