Thomas Fitzpatrick is President, HealthNow Administrative Services and Senior Vice President, Small Group Sales and Joint Administration Solutions for Highmark Inc., a part of Highmark Health. Mr. Fitzpatrick is ultimately responsible for growing membership and maintaining positive operating margin for 3 blocks of business that he is responsible for in Highmark’s footprint, which includes Pennsylvania, West Virginia and Delaware.
The Small Group business segment represents employers with 2-50 employees who are looking for affordability and innovative products & solutions. Joint Administration Solutions is a new venture for Highmark and has produced over 95,000 members in its first 2 years. HealthNow Adminstrative Services is a fully functional Third Party Administrator (TPA) with over 130K members and annual revenue of over $22M.
Mr. Fitzpatrick is responsible for motivating, coaching, setting strategy and providing direction to a staff of over 180 professionals who sell, solicit and negotiate products and services to employer groups. His most recent work has included taking on a leadership role within HealthNow Administrative Services. He also has responsibility for leadership and direction of the Joint Administration Solution team as well as Highmark's small group (2-50) sales team.
Prior to this position, he was the Senior Vice President of Provider Contracting, Partnerships and Shared Services, where he had responsibility for managing Highmark's Provider Network.
Mr. Fitzpatrick was responsible for creating and managing solid working relationships with Highmark’s network of providers (hospitals and physicians) and for negotiating the reimbursement rates which Highmark pays to hospitals and physicians in Highmark’s service area, which includes Pennsylvania, West Virginia and Delaware.
Tom was also responsible for many of the payment transformation initiatives that Highmark continues to implement, including, Highmark’s version of the Patient Centered Medical Home, called True Performance. He is also responsible for other value based reimbursement designs, including episodic and bundled payment as well as gain share and risk share models.
In this role Mr. Fitzpatrick was responsible for an organizational re-design that included a new field-deployment model that enabled providers to better manage large populations of patients and to better understand and succeed in their Pay for Value programs. A large part of his strategy work consisted of finding the right providers to partner with as well as to align the most appropriate alternative reimbursement methodology.
Prior to that role, Mr. Fitzpatrick was the Vice President of Strategic Markets (Sales) at Highmark where he had ultimate accountability for 117 large group customers, primarily high profile accounts and 34 hospital accounts. His book of business represented over 200,000 members and over $400M in premium revenue. In this role, Mr. Fitzpatrick was responsible for sales, implementation and overall administration of activities related to his clients, primarily health and wellness plans. His other responsibilities included developing and maintaining relationships with clients, motivating, coaching, and developing sales personnel to achieve and exceed retention goals and for overall market profitability for the Strategic Markets division of Highmark.
Mr. Fitzpatrick is very familiar with Highmark’s main distribution channel, the Producer/Broker network. He managed these relationships for 5 years as the Director of Small Group Sales and as the Director of Producer Affairs. He directed this division through a significant financial turn around that ultimately led to the creation of a for-profit, medically underwritten book of business for Highmark. He also introduced and implemented a tiered broker compensation and successfully migrated Highmark’s commission structure from a percentage of premium to per member per month.
Mr. Fitzpatrick is a graduate of the University of Delaware with a Bachelor of Science Degree in Human Resources. He has 27 years of experience in the insurance industry — twelve years specializing in insurance sales and seven years in provider contracting and relations. His successful sales experience at Highmark demonstrates his ability to create and develop many long-term client relationships. He firmly believes in corporate teamwork and is a valuable contributor to Highmark’s Strategic Planning process.
Mr. Fitzpatrick is also a graduate of Leadership Pittsburgh XXVI, Harvard University’s School of Negotiation and The Wharton Business Schools Leadership Series, he holds a resident producer license in the Commonwealth of Pennsylvania for Life, Accident, Health and Fixed Annuities.
He is very active in his community and serves as a youth football and basketball coach in the Upper St. Clair Athletic Association.
Thought Leadership Topics:
Leading through Challenging Times
Self-Insured Health Plans through the use of a TPA
Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration.
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