Thursday, August 30, 2018
New program to recognize the value of EMS services
PITTSBURGH (Aug. 30, 2018) — Highmark Blue Cross Blue Shield and Allegheny Health Network (AHN) announced today a pilot program to help ensure that ambulance services are reimbursed for certain types of calls to treat members and patients that do not result in transport to a hospital. Currently, Highmark's benefits and medical policy, similar to most insurers' policies, only allow payment for emergency ambulance services when the patient is transported to the emergency department.
The pilot program was announced at a press event with representatives of local EMS providers, Highmark and AHN.
"We want to ensure that ambulance services are paid appropriately and members receive appropriate care," said Robert Wanovich, vice president of Ancillary Provider Strategy and Management for Highmark Inc. "To that end, we collaborated with AHN and several EMS leaders to develop a program that reimburses the ambulance services when they treat our members on-site but don't end up taking them to the emergency room."
As part of the new pilot program, Highmark will contract with and reimburse participating EMS agency leaders for treatment of patients 18 years or older who present with hypoglycemia (low blood sugar), asthma/COPD attacks, or seizure disorder — without the requirement that they transport the member to the emergency department. The goal of the pilot is to reduce unnecessary ED visits and improve the overall patient experience, decrease health care costs, and ensure that ambulance services are paid fairly and members receive appropriate care.
Patients will receive on-scene treatment and assessment based on standard state approved EMS protocols and under the oversight of an AHN Emergency Medicine physician. AHN staff will also follow up via phone within 48 hours to check the patient's condition.
"As a hospital system, patient care is our highest priority. If patients who call for an ambulance in non-emergent situations can be assessed and treated on-site, that helps free up our emergency department and ED staff — as well as the ambulance service — for true emergencies and more efficient patient care," said Robert McCaughan, vice president, Prehospital Care Services, AHN. "This is one more example of Highmark and AHN working together — alongside our EMS partners — and getting healthcare right for the communities we serve."
And when EMS providers are reimbursed to provide on-site care, patients will also benefit.
"If patients can be treated appropriately on site, they don't have the added stress of leaving their families and traveling via ambulance to the ED," said McCaughan. "We believe this pilot program will prove to have benefits for patients, EMS providers, AHN, and Highmark."
Wanovich added that patient participation in the pilot program is voluntary. "If a patient wants to be transported to a hospital, they will be," he said.
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 Inc. and affiliates operate health insurance plans in Pennsylvania, Delaware and West Virginia that serve 5 million members and hundreds of thousands of additional members through the BlueCard® program. Its diversified businesses serve group customer and individual needs across the United States through dental insurance, vision care and other related businesses. Highmark Inc. 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.
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