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Highmark: Value-based program saved $260 million

Highmark headquarters, in Pittsburgh.

Pittsburgh-based Highmark Inc. said its value-based payment program saved the insurer more than $260 million within its first year.

The nonprofit insurer said that  its value-based program for primary-care physicians cut hospital readmissions 16 percent last year, which potentially saved $224 million. Further, it reported, an increased focus on prevention, including screenings and vaccinations, helped saved an estimated $38 million in avoidable emergency room visits.

This seems to be a trend. For instance, UnitedHealthcare expanded its bundled-payment program in May after it netted $18 million in savings from a total of 115 employers in the program since 2016.

To read Highmark’s press release, please hit this link.

To read FierceHealthcare’s report, please hit this link.


Physicians group threaten quota system for ACA patients


Highmark headquarters in downtown Pittsburgh.

The Pittsburgh-Tribune Review reports that Highmark Inc. will cut payments to physicians by 4.5 percent starting April 1 after a $500 million loss last year on  Highmark insurance plans sold on the Affordable Care Act marketplace.

Highmark officials say that the people who signed up through the ACA’S marketplace were sicker than the insurer expected.

But John Krah, executive director of the Allegheny County Medical Society, said physicians shouldn’t be held responsible for Highmark setting plan costs too low to cover care.

He said that  doctors might end up setting quotas for how many of the ACA-linked patients they would accept at their practices,  as they do for Medicare and Medicaid patients.

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