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PinnacleHealth and Highmark Inc. announce cancer collaborative

Episodic-payment initiative aimed at paying for value in breast cancer care

Highmark Inc.

PITTSBURGH (June 29, 2016) — Today PinnacleHealth and Highmark Inc. announced that PinnacleHealth will participate in the Highmark Cancer Collaborative through an episode-of-care payment arrangement that applies to breast cancer diagnoses treated with outpatient radiation.

The Highmark Cancer Collaborative was launched by Highmark and the Allegheny Health Network (AHN) Cancer Institute in western Pennsylvania in March 2016 to create a replicable model for the creation and dissemination of best practices in cancer care.

"Today's announcement marks the first expansion of the collaborative to additional regions throughout Highmark's service plan, partnering with local health care providers," said Deborah Rice-Johnson, president, Highmark Health Plan. "The Highmark Cancer Collaborative aims to provide the best possible cancer care and value through a multi-disciplinary team of forward-thinking clinicians; top hospitals and medical research institutions; and Highmark, a leading health insurer. It improves how cancer treatment decisions are made, how cancer care is delivered and paid for, and how key stakeholders work together to fight cancer at a fundamental level."

The Highmark Cancer Collaborative agreement with PinnacleHealth aims to transform cancer patients' treatment experience by maximizing comfort, safety, outcomes and financial well-being. The arrangement simplifies care for the provider and the patient by eliminating prior authorization for radiation therapy treatment of breast cancer at PinnacleHealth facilities.

"Beyond compassionate, supportive and personalized relationships with our patients, we're always focused on providing the highest quality care with the best outcomes," said Michael Young, president and CEO of PinnacleHealth. "This new arrangement is a natural extension of those goals and our work to reduce healthcare costs for the community and local employers."

The PinnacleHealth arrangement includes a unique reimbursement method that rewards best practices, including use of Highmark's treatment pathways. Treatment pathways are primarily selected based upon National Comprehensive Cancer Care Network treatment guidelines, which are also the basis of PinnacleHealth's oncological treatments.

The initiative also provides tools to help oncologists compare planned cancer treatment regimens against evidence-based clinical criteria. Under this arrangement, radiation oncologists have the flexibility to choose the most appropriate treatment for each individual's care.

"Our goal with this collaborative is to create decision support tools to guide physicians based on the most advanced medical science. The idea is to reduce pockets of unwarranted variation in cancer care while ensuring that leading-edge cancer treatment protocols are available to everyone who needs them," said Virginia Calega, M.D., vice president of strategic clinical solutions at Highmark. "Nationally, cancer care can be fragmented due to its complexity, and our collaborative is working to address that issue."

Guidelines, protocols, tools and decision support software are continuously vetted and updated by leading experts in the field.

The episode-of-care payment arrangement applies to commercial health plan members enrolled in employer coverage that includes Highmark's Radiation Oncology Management Program.

About PinnacleHealth

PinnacleHealth System has been a leading provider of inpatient and outpatient healthcare services in central Pennsylvania since 1873. The 636-bed system has three acute care hospitals (Community General Osteopathic, Harrisburg and West Shore Hospitals) on four campuses (Community, Harrisburg, Polyclinic and West Shore) serving a five-county service area and supporting rural hospitals through affiliations and telehealth services. PinnacleHealth pursues innovative treatment options for the region through cardiac and cancer clinical trials, while offering convenient community services including medical home-certified primary care, urgent care, Magnet-recognized nursing excellence, emergency services, imaging, high-volume maternity care and a level III NICU, and workplace-based wellness services. PinnacleHealth includes a CardioVascular Institute and Cancer Institute, as well as a Bone and Joint Institute, Neurosurgery and Neurosciences Institute, and Spine Care Center that combine a multi-disciplinary approach to comprehensive spine, bone, joint, orthopedic and sports medicine services. PinnacleHealth is recognized for high-quality care with national and regional recognitions for volumes, outcomes and safety. For more information, visit www.pinnaclehealth.org.

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.

For more information, contact:
Leilyn Perri
Highmark Health
717-302-4243
leilyn.perri@highmarkhealth.org