Highmark’s True Performance program tops $3 billion in avoided costs

PITTSBURGH (September 6, 2023) — Highmark Inc.’s True Performance value-based reimbursement program for Primary Care Physicians (PCPs) has achieved more than $3 billion in avoided cost savings in Pennsylvania, Delaware and West Virginia since 2017 due to better health management.

Avoided costs are realized when inpatient hospital admissions and Emergency Department (ED) visits for members seeing True Performance PCPs are reduced, based on the average costs for those services.

In 2022, avoided cost for reduced inpatient admissions totaled $632 million across Highmark’s service areas in Pennsylvania, Delaware and West Virginia. Avoided costs for ED visits totaled $106 million across Pennsylvania, Delaware and West Virginia in the same time period.

“The True Performance program has really shown results as we work to reduce health care costs for our customers and members and improve health outcomes,” said Dr. Timothy Law, chief medical officer for Highmark Inc. “And reducing hospital admissions and ED visits also shows that PCPs in the True Performance program are keeping our members healthier.” 

Dr. Law added that the True Performance program also helps ensure that PCPs are meeting nationally-recognized quality measures such as giving recommended immunizations, appropriate drug therapy for patients with chronic diseases, cancer screenings and annual wellness exams.

Approximately 90 percent of all eligible PCPs in Pennsylvania, Delaware and West Virginia participate in True Performance — that’s more than 13,000 participating physicians from more than 2,100 practices.

There are 2.2 million Highmark members currently seeing a PCP that is participating in the True Performance program.