Highmark's new alliance could pay docs 30% more for coordinating care

Highmark has taken a major step toward coordinating patient care, lowering health costs and shifting from a volume- to value-based payment system. Pennsylvania's largest insurer announced Thursday that it's launching an "accountable care alliance" that will pay a network of about 500 hospitals and doctors up to 30 percent more in reimbursements for keeping patients healthy.

By improving the coordination of care among providers, Highmark hopes its new program, which will incorporate technology and industry best practices, enhances quality of care, reduces hospital visits and bends the cost curve by 3 percent to 5 percent per patient, the insurer said in an announcement.

"This is a program that is built around quality," Paul Kaplan, Highmark's senior vice president of provider integration, told the Pittsburgh Post-Gazette. He said the goal is for participating members to say, "I got what I needed, I got it when I needed it. And the price is right."

Although Highmark compared its new alliance to the accountable care organizations initially launched by Medicare, officials said their program differs in one key aspect--it doesn't require risk sharing by participating providers yet. The alliance will take full shape over the next three years, so it's still possible that Highmark will incorporate a full risk-sharing model in the future.

"We're not even sure if that is the right model," said Mike Fiaschetti, Highmark's president of health markets, referring to the Medicare ACO program. "The last thing we want to do is give any incentive to not deliver care," he told the Pittsburgh Tribune-Review.

To learn more:
- here's the Highmark announcement
- read the Pittsburgh Post-Gazette article
- see the Pittsburgh Tribune-Review article