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.

MEDIA NOTE:

Contact Anthony Matrisciano with Highmark Health @ 570-574-0050 or anthony.matrisciano@highmarkhealth.org to arrange an interview with Dr. Fickie prior to the conference.