When care providers have close relationships with health insurance payers, the result is a healthier community. Providers and payers work together with the same goals for the people and places they serve. It’s a collaboration that benefits employers and their group plan members in many ways.
Dr. Bruce Meyer, EVP, Market President for Western Pennsylvania and West Virginia leads this effort for Highmark’s health plans. He and his team develop collaborations that support whole-person health for people in rural and urban locations alike.
Highmark works with Allegheny Health Network (AHN), a system of 14 hospitals and dozens of clinics in Western Pennsylvania. It’s the ideal scenario for close provider relationships. Highmark has provided a grant for new AHN locations that are being built in underserved areas and is engaged with other regional provider groups and health systems.
“We partner with providers who share our belief in whole-person health,” states Dr. Meyer. “Together, we can reduce clinical variation and duplication of services and enhance preventive care for our communities.” These relationships are integral in delivering chronic disease management programs and ensuring mental health gets addressed.
Payer and provider connections also include a network that can help with social determinants of health (SDOH) needs. SDOH issues like food insecurity, financial stress, lack of transportation, and unsafe living conditions can be mitigated or managed. What payers and providers can’t remedy, community and faith-based organizations often can.
“Close provider relationships do not mean close physical proximity,” explains Dr. Meyer. “Our service area covers wide geographies — across bridges, through tunnels, and over mountaintops.”
Another challenge in delivering quality care to rural Highmark members is the “digital divide.” Some communities and individuals lack the access to technology that enables virtual visits and remote health monitoring. Close relationships allow providers and payers to find innovative solutions that work for everyone.
For example, Highmark has collaborated with providers to give temporary tablet computers to members with chronic and consistent health needs. Members can reach their care teams whenever necessary and schedule regular virtual visits to monitor progress. Home care also plays a role in breaking down barriers to quality care.
One area where Highmark is merging virtual and home care for rural members is post-operative wound evaluation. Right now, over 40% of post-op members are successfully treated this way. Highmark hopes to increase that number to 80% over time.
Highmark encourages all members to complete an in-depth health risk assessment. The assessment gathers individual data on:
This information creates a whole-person profile that drives interventions for preventive and specialty care, as well as SDOH needs. For example, Highmark has collaborations that help members with food insecurity, social engagement, budgeting, financial planning, and payment plans for medical bills.
“Members get treated as people with uniquely individual medical and nonmedical challenges,” says Dr. Meyer. “Each member receives what they need to achieve positive outcomes and live a better and more healthful life. This is the virtuous cycle.”
The savings from disease prevention and chronic condition management lower overall health care costs for the employer. The employer can invest those dollars in additional health and wellness programs, completing the virtuous cycle.
For employers, the outcome of personalized care is twofold. Group health plan cost trends decrease through proactive preventive care that can help avert chronic disease. Employees become more active, motivated, productive, and present, with less time away from work.
Highmark has a clear vision and value proposition for employers: improve employee health in a sustainable way and control costs. “It takes a little time to understand the big picture and how health care costs impact the bottom line,” says Dr. Meyer. “But we have had tremendous success in enhancing member satisfaction and health care outcomes.”
Dr. Meyer’s team is on a journey to educate providers, members, and community partners. Highmark wants to help primary care providers understand each member as a whole person and address their health issues. Beyond telling them to exercise or eat better — giving them the tools, via Highmark, to do so.
“What we’re doing is different,” Dr. Meyer concludes. “Our model serves the individual, the provider, and the community. Together, we’re creating a better system to overcome barriers to quality care.”
All references to “Highmark” in this communication are references to Highmark Inc., an independent licensee of the Blue Cross Blue Shield Association, and/or to one or more of its affiliated Blue companies.
Talk to your client manager today and we’ll help you find the right health plan for your company.
