Physicians Helping Highmark’s True Performance Program to Succeed

Highmark’s True Performance Program Avoided More than $260 Million in Health Costs in 2017

When PCPs helped Highmark launch its True Performance program in January 2017, the goal was to improve health care quality outcomes for members, reduce annual increases in total health care costs, and help physicians engage in patient care coordination and population health management.

True Performance is a value-based reimbursement program for PCPs focused on affordability and quality of health care for Highmark members. The program evaluates a PCP’s ability to deliver the right care at the right time and in the most appropriate setting, and it rewards PCPs for their performance on quality and cost/utilization measures.

Highmark’s claims data through the end of 2017 are now showing the results of the True Performance program, and they have exceeded expectations — with more than $260 million in avoided health costs to date.

“PCPs have an enormous influence on our members’ health — from routine visits to prescribing medications to referrals to specialists — and that is why the True Performance program focuses on PCPs,” said Charles DeShazer, MD, senior vice president and chief medical officer, Highmark Health Plan. “And we have seen great success in the first year.”

According to Dr. DeShazer, Highmark members who are seeing a PCP in the True Performance program had 11 percent fewer ER visits in 2017 than members seeing a PCP who is not in the program.

“True Performance helps physicians focus on prevention and wellness — they are evaluated on meeting nationally recognized quality measures, such as ensuring members receive appropriate screenings and vaccinations,” Dr. DeShazer said. “Those prevention and wellness efforts are helping to keep our members out of the ER, and we estimate that potentially avoided costs were over $38 million in just the first year of the True Performance program.”

Additionally, members seeing a PCP in the True Performance program had 16 percent fewer inpatient admissions in 2017 compared to members seeing a PCP who is not in the program — at a potentially avoided cost of $224 million.

“True Performance also evaluates physicians on how they help members manage chronic illnesses such as diabetes, heart disease, and asthma,” Dr. DeShazer added. “When those conditions are properly managed, costly inpatient hospital stays related to chronic illnesses can be avoided.”

While cost savings and better health are certainly good for patients and members, PCPs are also seeing benefits from True Performance. Through collaboration with Highmark, they receive the support and information needed to thrive in the new environment of value-based care.

“The True Performance program is a ‘true’ collaboration between the provider and Highmark that recognizes our commitment to quality and also provides us with data tools, plus personalized support, to help us provide better care for our patients,” said Bill Johnjulio, MD, chair of the Allegheny Health Network (AHN) Primary Care Institute in Pittsburgh. “True Performance also provides a new payment model that helps us fund reinvestments to support the transformation in how we provide a higher level of personalized care. It truly is a win-win-win situation for our patients, providers, and Highmark.”