Highmark saves more than $1 billion in avoided cost with True Performance program

PITTSBURGH (October 5, 2020) — Highmark Inc. has announced that its True Performance initiative — one of the largest risk- and value-based reimbursement programs for Primary Care Physicians (PCPs) in the country — has achieved more than $1 billion in avoided cost savings in just three years, while also improving outcomes for members.

Highmark’s claims data for years 2017, 2018 and 2019 has shown that the program focused on affordability and quality of health for members has helped to avoid a total of $1.09 billion in health care costs from Emergency Department (ED) visits and hospital admissions. 

“We’re proud of the results of True Performance as our flagship value-based reimbursement program that drives quality and cost containment for our employer customers and our members,” said Sean Burns, vice president of provider payment for Highmark. “True Performance incentivizes PCPs to deliver the right care at the right time and in the most appropriate setting, and that helps keep customers’ employees and our members healthier, which means fewer ED visits and hospital stays.” 

The True Performance program also aligns with Highmark’s strategy of high performance networks and products that, together, help lower customers’ total cost of care, said Burns.

Improving outcomes, reducing costs

Highmark members seeing a PCP who participates in the True Performance program have fewer ED visits than members seeing a PCP that does not participate in the program, leading to more than $40 million in avoided costs in 2019 alone.

“True Performance rewards PCPs for meeting nationally-recognized quality measures such as ensuring that members receive recommended immunizations, appropriate drug therapy for patients with chronic diseases, cancer screenings and annual wellness exams,” said Burns. “This helps to ensure that our members are engaged in preventive care and care coordination to stay healthy and avoid more costly care later.”

Preventive care and care coordination also resulted in members seeing a PCP who participates in the True Performance program having fewer inpatient admissions in 2019 compared to members seeing a PCP that is not in the program — at a care cost savings of $437 million.

PCPs in the True Performance program also receive ongoing support and up-to-date information on best practices from Highmark to continue the transition to value-based care models.

According to Burns, approximately 84 percent of all eligible PCPs in Highmark’s service areas participate in True Performance — that’s nearly 11,000 participating physicians from more than 2,000 practices.

Nearly 2 million Highmark members are currently seeing a PCP that is participating in the True Performance program.

Highmark has also announced that many of its value-based provider reimbursement programs, including the Primary Care, Specialty Care, and Hospital programs, will now align under the True Performance program and the True Performance name.