Highmark Inc. is offering a new health care approach, Total Health, for larger employer groups in Delaware. Highmark is the largest health insurer in the state.
According to a release, Total Health uses a ” patient-centered medical home, led by a primary care physician, coordinates patient care by a team of care providers of various skill sets to improve communication, reduce duplication of services, increase care quality and lower costs. The team uses electronic health records and decision support tools to best manage the patients under its care.”
The model, along with Highmark’s Accountable Care Alliance, are part of a pay-for-value approach to health care, which focuses on improved patient outcomes and reduced costs, according to the release.
“The medical care teams within our alliance and patient-centered medical homes are rewarded for improving the value of care delivery by assuring improved outcomes at lower cost,” said Donald R. Fischer, M.D., Highmark’s senior vice president and chief medical officer. “We want our members and their employers to know that with Total Health, the patient experience will be enhanced by facilitating better care coordination, improved communication among the care team, and better adherence to evidence-based medicine to control their medical costs.”
Total Health is an option for self-insured companies in Delaware with more than 100 employees. Coverage will take effect on Jan. 1, 2015.
Dr. Fischer noted that outcomes that can result from the pay-for-value approach include better provider-facility communications, fewer unnecessary tests, online patient services, evidence-based treatment protocols and improved patient access to care.
Highmark’s Total Health product is offered in two versions, depending on the pay-for-value model and geographic region.
PPO Blue Total Health, built on Highmark’s broad network, offers lower cost sharing for office visits to people receiving primary care at one of 773 participating PCMH practices with about 3,335 medical practitioners in Highmark’s Pennsylvania and Delaware markets. The select network Community Blue Total Health plan offers the same but is available only in Western Pennsylvania.
For members at companies with more than 50 employees, PPO Blue Total Health and Community Blue Total Health can also reduce cost sharing for those dealing with certain chronic conditions. Those include asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure, coronary artery disease, diabetes, high blood pressure and high cholesterol, according to the company.
Many of the above conditions often end up with expensive stays in the hospital.
The new offering comes at the time when major changes are under way in health care delivery
Christiana Care, the state’s largest private employer and health care provider, is moving toward a model that “bundles” prices for procedures and treatments, rather than billing for each service offered. The goal is to improve quality of care in a cost-effective manner.
Christiana Care has also made changes to its health care plan with the aim of improving outcomes. Geisinger Health Plan in Pennsylvania will handle third-party administration. Click here for further information from a previous Business Daily story.
