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True Performance Program Achieves Successes in Inaugural Year

Highmark launched the True Performance value-based incentive program for eligible network PCPs on Jan. 1, 2017. The program strives to improve health care quality and the patient experience while reducing the overall cost of care for Highmark members.

During its first year, True Performance made significant strides in achieving those goals, which can result in better outcomes and more efficient care delivery.

Notable successes from 2017 include the reduction of emergency department use and inpatient admissions to address inappropriate or unnecessary utilization. Specifically, year-to-date improvement rates in those True Performance quality indicators for participating versus non-participating PCPs were:

  • True Performance providers' emergency department utilization was 13.1 percent lower than those not in the program.
  • True Performance providers recorded inpatient admission utilization at a 16.3 percent lower rate than those not in the program.

With an emergency department visit averaging $1,123 and an inpatient admission costing $12,782 on average across Highmark's networks, True Performance providers are demonstrating that they are improving care while helping to control escalating health care costs.

By averting emergency department visits and inpatient admissions when they truly are inappropriate or unnecessary, True Performance providers have helped to achieve year-to-date avoided costs of $26.3 million in emergency department use and $153.5 million for inpatient admissions.

True Performance Rewards Outcomes

With 7,400 participating physicians, True Performance is one of the largest value-based programs of its kind in the United States.

True Performance providers are reimbursed in part based on the health outcomes of their Highmark patients, rather than solely on the volume of services they provide. The program emphasizes delivering the right care at the right time and in the most appropriate setting — and helping patients get better or avoid illness.

Participating PCPs need to meet certain quality and cost measures to earn a reimbursement incentive. Patients should receive certain preventive and treatment services, such as childhood immunizations, appropriate drug therapy for chronic diseases, cancer screenings, and annual wellness exams — all key to keeping patients healthier. This helps our members avoid more costly care later.

True Performance also encourages PCP-specialist collaboration that can lead to more efficient care processes while maintaining high-quality health care for 1.8 million Highmark members. Among these process improvement goals is better communication with patients to help them make more informed decisions that will keep them healthier.

Watch Provider News for updates on how Highmark and participating physicians are improving care quality and outcomes through True Performance. 

 

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