Highmark pilot programs benefiting providers and members
Tuesday, February 21, 2023
Highmark pilot programs benefiting providers and members
PITTSBURGH (February 21, 2023) — Pilot programs can be an important step in showing the usefulness and effectiveness of a new product or service. Health insurers often use pilot programs to test how members may benefit from a new drug or medical device, or to develop programs and best practices to address chronic conditions or clinical issues.
One such issue recognized by Highmark was the occurrence of gastroesophageal reflux disease (GERD) and weight gain in members following bariatric surgery. Highmark helped fund a study led by Dr. George Eid, Chair of the Allegheny Health Network (AHN) Bariatric and Metabolic Institute, to understand if a newer procedure can help reduce these symptoms.
The goal of the study for Highmark is to measure weight gain or loss and GERD symptoms before and after the endoscopic procedure to help inform future coverage decisions.
The procedure, known as ‘endoscopic gastrojejunostomy revision,’ was first performed at AHN Wexford Hospital as part of the study. The minimally invasive procedure reinforces the gastric pouch in gastric bypass patients who are experiencing reflux issues and weight gain following their initial gastric bypass surgery. With no external incisions required, most patients are able to return home on the same day as their surgery and recover more quickly.
“Our pilot programs at Highmark first and foremost look at the clinical effectiveness of a procedure, device or program and how it will benefit our members,” said Highmark’s Senior Medical Director for Medical Policy Matt Fickie, MD. “The secondary outcome must be cost effectiveness, which also benefits our members. These are the key determinates for Highmark to consider a pilot with a vendor or provider.”
Based on the outcomes of its pilot programs, Dr. Fickie has been selected to speak at the 30th Anniversary Molecular and Precision Med TRI-CON conference March 6-8 in San Diego, California.
Dr. Fickie will join a panel discussion titled Payer Partnerships: Urban Myth or Golden Ticket? Dr. Fickie will discuss how Highmark identifies partners for pilots and value-based contracts that benefit both the provider and the payer.
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, West Virginia and New York. 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.
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 and/or to one or more of its affiliated Blue companies. This website is operated by Highmark, Inc. and is not the Health Insurance Marketplace website. It also does not display all Qualified Health Plans available through the Health Insurance Marketplace website. To see all available Qualified Health Plan options, go to the Health Insurance Marketplace website at HealthCare.gov.
Highmark Blue Cross Blue Shield or Highmark Blue Shield are Medicare Advantage HMO, PPO, and/or Part D plans with a Medicare contract. Enrollment in these plans depends on contract renewal. ®Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Benefits and/or benefit administration may be provided by or through the following entities, which are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company. PA: Your plan may not cover all your health care expenses. Read your plan materials carefully to determine which health care services are covered. For more information, call the number on the back of your member ID card or, if not a member, call 866-459-4418. Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield. West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Visit our website to view the Access Plan required by the Health Benefit Plan Network Access and Adequacy Act. You may also request a copy by contacting us at the number on the back of your ID card. Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield. Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.
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