Up to $5.5 million available to Pennsylvania primary care physicians through Highmark program aimed at patient-focused care
PITTSBURGH (May 3, 2016) In an effort to improve continuity, quality and timely coordination of care for its members with chronic conditions, Highmark today affirmed its patient-focused approach to care by making available up to $5.5 million in compensation for primary care physicians to address unconfirmed diagnosis codes.
"Primary care physicians are critical partners with us in managing our members' care, especially those with complex chronic conditions," said Highmark Vice President and Medical Director Amy Fahrenkopf, M.D. "This effort compensates doctors who are working with our members in government-focused programs, ties our reimbursement to high-quality care and allows us to better serve some of our most vulnerable patients with care management and coaching."
The program is designed to ensure the accurate identification, assessment, documentation and reporting of diagnosis codes. It applies to some 2,800 Pennsylvania primary care physicians who see some 200,000 members with Highmark Medicare Advantage or Affordable Care Act (ACA) health plans.
"Each of these government-focused programs pay health plans for the health risk associated with their members," added Fahrenkopf. "As our focus on unconfirmed diagnosis codes becomes more widely accepted with physician reporting, there is also a direct correlation to the moderation of insurance premiums for these members' plans."
Highmark has compensated primary care physicians for confirming and documenting patient diagnoses in the past, however, the latest efforts make more funding available for physicians who accurately complete documentation on a higher percentage of their patient base.
About Highmark Inc.
Highmark Inc. and its health insurance subsidiaries and affiliates collectively are among the ten largest health insurers in the United States and comprise the fourth largest Blue Cross and Blue Shield-affiliated organization. Highmark and its diversified businesses and affiliates operate health insurance plans in Pennsylvania, Delaware and West Virginia that serve 5.2 million members and hundreds of thousands of additional members through the Blue Card program. Its diversified businesses serve group customer and individual needs across the United States through dental insurance, vision care and other related businesses. Highmark is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information, visit www.highmark.com.