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The difference you can make when you're all for health.

Making health care better

Deep brain stimulation

Our living proof stories show how members like you achieve better health when we focus on improving the quality of care.

But what does quality really mean when it comes to health care? Is it…

  • A rapid recovery from surgery?
  • Having a doctor who explains your diagnosis in a way you can understand?
  • Free parking and a friendly office staff?
  • A same day appointment when you need it?
  • Health care professionals who treat you like a unique individual?

All these things are important, and they are why we are working with your doctors to define and deliver a better health care experience for you.

Creating new standards for cancer care

Highmark members have access to the best possible cancer care, coverage and medical research. In western Pennsylvania, Highmark and the Allegheny Health Network (AHN) Cancer Institute are working together with Johns Hopkins Kimmel Cancer Center on the Highmark Cancer Collaborative.

Together we're establishing new standards for cancer care for western Pennsylvania. Not only will these new standards help control costs, they will also improve the care you receive if you need cancer treatment.

"If doctors follow the guidelines, fewer patients will undergo treatments that don't work for them or that cause unnecessary side effects," said Dr. Ginny Calega, Highmark's vice president of strategic clinical solutions. "By avoiding ineffective treatments, patients could recover faster and pay less."

Connecting with the right mental health care doctors sooner

Many people don't seek mental health care to help them cope with life's problems, often delaying until they're at a crisis. Highmark is working with a new health technology company to integrate mental health into primary care.

Together, Highmark is offering primary care physicians (PCPs) a new program to help them give their patients complete, holistic care, covering both emotional and physical health.

Through a review of clinical claims data, the program identifies and contacts members with complex health situations who may benefit from behavioral health care. Their PCPs are also contacted so they can be more proactive with their patients' care.

The program also makes it easier and quicker for PCPs to refer Highmark members to the right mental health specialist to meet their needs. It uses technology to make a connection between in-network PCPs, the psychiatric counselors and the member.

Because mental health counselors can review details about the member's needs online, during the referral process, they know if they're a good match. Both in-person and tele-psychiatry are offered.

Appointments can be scheduled sooner, and compliance and follow-up should result in better outcomes. So Highmark members can get the right type and right level of therapy, with fewer delays.

Severely ill members gain the comfort of skilled care at home

Members with a serious illness can get care amid the comforts of family and home, rather than at a hospital.

Compassionate, skilled home health staff help these members manage pain, sickness and other symptoms, communicate with family members, prevent a crisis, and plan for advanced care and emergencies.

People stay safe, have less pain

People with pain need the right levels of medicine to relieve their pain, stay safe and heal faster. We give doctors data about the most appropriate prescriptions, and alternatives to medication, so members get the treatment they need, and gain as much pain relief and daily functioning as possible. They are also more likely to avoid addiction or misuse from poorly supervised drug therapy.

Working together with doctors for better care

When doctors and health plans work together, we can agree on guidelines for specific treatments, so each patient gets a better outcome. We even collaborate on health plan designs, so that coverage makes sense for doctors and their patients.

Health care shouldn't be a hassle. When we set these guidelines together, doctors are free to make medical decisions without interference from procedures like prior authorizations. So you can put your trust in your doctor to care for you.

Meanwhile, we will work with your care team to make sure that the guidelines we create together will give you the best possible outcome.

Rewarding care that is top quality

We are even changing the way we pay primary care doctors for the care they deliver. Rather than paying them for individual services, which might not actually lead to better health for you, we developed a program to reward primary care physicians for actual health outcomes.

  • Our True Performance program measures a doctor's quality, cost and utilization against agreed-upon quality benchmarks.
  • Doctors who achieve and maintain those high standards are then rewarded appropriately.
  • They coordinate care with specialists and support PCPs' efforts to reduce care costs.

The goal is to give you access to top quality care by emphasizing the value of care delivered to you and rewarding PCPs who maintain high standards.

Keeping preventive guidelines relevant

Times change, and so should preventive guidelines. We'll make sure that you know exactly what you need to do to stay healthy. Doctors in your community help us to update our preventive guidelines, making sure that:

  • Critical exams are recommended and covered.
  • You can get the preventive care you need without worrying about the cost.
  • We catch serious illnesses early enough for the most effective treatment.

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