Highmark's use of advanced technology improves outcomes and lowers costs

PITTSBURGH (November 16, 2021) — Highmark Inc.’s strategy of utilizing advanced technology to improve care management programs for members has shown positive outcomes and reduced health care costs.

Through methods such as predictive analytics, Highmark is able to use its data to identify members who may benefit from high-intensity care management programs, or other wellness and care programs to prevent chronic diseases such as diabetes or heart disease.

“We are using technology successfully to base our members’ care on what we know works, with insight from real-world data,” said Ian Blunt, vice president of Advanced Analytics for Highmark. “This advanced technology and data then helps us give the right member the right care at the right time, which has been shown to improve outcomes and reduce costs.”

Use of advanced analytics is not limited to informing how care is deployed, however. Highmark is also using advanced technology to evaluate the impact of the care management programs it offers. This helps to objectively determine what is working and what is not working for members, compared to people who do not receive intervention.

For example, Blunt said Highmark has seen a $721 per member, per month reduction of health care costs for employer group customers through Highmark’s Transition of Care program, which helps coordinate the continuity of care when a member leaves the hospital for another facility or for home care.  

These cost reductions were realized through reductions in readmissions and average inpatient length of stay, and lower utilization of skilled nursing, long-term acute care and inpatient rehab facilities for members in the program.

Additionally, Highmark has seen an $850 per month, per member reduction in medical cost savings in the Federal Employee Program (FEP) through the Complex Case Management program. Complex Case Management helps members recovering from a hospital admission, dealing with multiple medical problems or facing catastrophic needs navigate the health care system to get the follow-up or continuing care they need to get better.

“We are using evaluation methodology that is consistent with academic standards,” said Benjamin Edelshain, MD, vice president, Clinical Engagement & Digital Innovation for Highmark Inc. “This means we can more accurately understand how our care management programs are helping — or not helping — our members, and make proper adjustments to ensure members are getting the maximum benefit from their care.”

Members can find more information on Highmark’s care management programs through the online member portal or by calling the toll-free number on the back of their Highmark insurance card.