Highmark's True Performance program tops $4 billion in avoided costs

PITTSBURGH (December 4, 2024) — Highmark Inc.’s True Performance value-based reimbursement program for Primary Care Physicians (PCPs) has achieved more than $4 billion in avoided cost savings in Pennsylvania, Delaware and West Virginia since 2017 due to better health management.

Avoided costs are realized when inpatient hospital admissions and Emergency Department (ED) visits for members seeing True Performance PCPs are reduced, based on the average costs for those services.

In 2023, True Performance providers had lower inpatient admissions than those not in the program with potentially avoided costs of $766 million across Highmark’s service areas in Pennsylvania, Delaware and West Virginia. True Performance providers also had lower ED Utilization than those not in the program with potentially avoided costs of $114.9 million.

Based on these positive results, Highmark is now expanding the True Performance program to providers in its service areas in New York starting January 1, 2025. True Performance will be the first Blue incentive program of its kind in the Empire State, with the potential to reach several hundred PCP practices.

“True Performance is the next step in Highmark’s mission to transform how health care is provided in New York,” says Sarah Cotter, Vice President of Markets for Highmark Western and Northeastern New York. “We emphasize supporting people’s health rather than treating them after something goes wrong.”

True Performance will replace several older incentive programs for New York PCPs who have at least 250 attributed members. “We are excited to offer our New York providers a streamlined focus through this innovative program,” Ms. Cotter notes. “It will truly benefit PCPs who excel at keeping patients healthy and helping members with chronic conditions like asthma and diabetes stay in control and avoid emergency care or hospital stays,” she says.

True Performance evaluates PCPs’ ability to deliver the right care at the right time and in the most appropriate setting through its intense focus on care coordination and population health management principles. PCPs are rewarded for their performance on quality and cost/utilization metrics.

Physicians in True Performance receive practice-level data sharing and timely and actionable reports that provide regular insight into which care and referral decisions contribute to optimum results for quality, outcomes, and value.

“Highmark is committed to collaborating with physicians to deliver improved outcomes and a remarkable health experience for our members,” Ms. Cotter says.

While results can vary by market and year to year, since the start of True Performance in 2017, Highmark customers are seeing a combined average per-member, per-month (PMPM) net cost savings of 3.2 percent.

True Performance is also one of the largest risk-based PCP value-based reimbursement programs in the country with 93.4 percent of all eligible PCPs in Highmark’s service areas participating. That adds up to more than 13,500 participating physicians from more than 2,300 practices.

There are 2.35 million Highmark members currently seeing a PCP that is participating in the True Performance program.