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Thomas Fitzpatrick is Senior Vice President, Provider Contracting, Relations, Partnerships, and Shared Services for Highmark Inc., a part of Highmark Health. Mr. Fitzpatrick is ultimately responsible for maintaining positive working relationships with Highmark’s network of providers (Hospitals and Physicians) and for negotiating the reimbursement rates which Highmark pays to hospitals and physicians in Highmark’s service area, which includes Pennsylvania, West Virginia and Delaware.
He is also responsible for many of the payment transformation initiatives that Highmark continues to implement, including, Highmark’s version of the Patient Centered Medical Home, called True Performance. He is also responsible for other value based reimbursement designs, including episodic and bundled payment as well as gain share and risk share models.
He is also responsible for all of the servicing that Highmark makes available to its providers, both web-based and face to face. His team is responsible for managing Highmark’s provider portal, provider communication as well as all field deployment resources.
Mr. Fitzpatrick is responsible for motivating, coaching, setting strategy and providing direction to a staff of 140 professionals who perform rate negotiations, contract analysis, provider relations and provider servicing. His most recent work has included an organizational redesign that includes a field-deployment model that enables providers to better manage large populations of patients and to better understand and succeed in our Pay for Value care models. A large part of his strategy work consists of finding the right providers to partner with as well as to align the most appropriate alternative reimbursement methodology that will help to control the rising health care costs in the region.
Prior to this position, he was the Vice President of Strategic Markets (Sales) at Highmark where he had ultimate accountability for 117 large group customers, primarily high profile accounts and 34 Hospital accounts. His book of business represented over 200,000 members and over $400M in premium revenue. In this role, Mr. Fitzpatrick was responsible for sales, implementation and overall administration of activities related to his clients, primarily health and wellness plans. His other responsibilities included developing and maintaining relationships with clients, motivating, coaching, and developing sales personnel to achieve and exceed retention goals and for overall market profitability for the Strategic Markets division of Highmark.
Mr. Fitzpatrick is very familiar with Highmark’s main distribution channel, the Producer/Broker network. He managed these relationships for 5 years as the Director of Small Group Sales and as the Director of Producer Affairs. He directed this division through a significant financial turn-around that ultimately led to the creation of a for profit, medically underwritten book of business for Highmark. He also introduced and implemented a tiered broker compensation and successfully migrated Highmark’s commission structure from a percentage of premium to per member per month.
Mr. Fitzpatrick is a graduate of the University of Delaware with a Bachelor of Science Degree in Human Resources. He has 25 years of experience in the insurance industry. Twelve years specializing in insurance sales and seven years in provider contracting & relations. His successful sales experience at Highmark demonstrates his ability to create and develop many long-term client relationships. He firmly believes in corporate teamwork and is a valuable contributor to Highmark’s Strategic Planning process.
Mr. Fitzpatrick is also a graduate of Leadership Pittsburgh XXVI, Harvard University’s School of Negotiation and holds a resident producer license in the Commonwealth of Pennsylvania for Life, Accident, Health and Fixed Annuities.
He is very active in his community and serves as a youth football and basketball coach in the Upper St. Clair Athletic Association.
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