Tuesday, November 16, 2021
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.
About Highmark Inc.
One of America's leading health insurance organizations and an independent licensee of the Blue Cross Blue Shield Association, Highmark Inc. (the Health Plan) and its affiliated health plans (collectively, the Health Plans) work passionately to deliver high-quality, accessible, understandable, and affordable experiences, outcomes, and solutions to customers. As the fourth-largest overall Blue Cross Blue Shield-affiliated organization, Highmark Inc. and its Blue-branded affiliates proudly cover the insurance needs of more than 6 million members in Pennsylvania, Delaware, New York and West Virginia. Its diversified businesses serve group customer and individual needs across the United States through dental insurance and other related businesses. For more information, visit www.highmark.com.
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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 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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