Highmark’s imposing headquarters in downtown Pittsburgh.
Following some other major insurers, Pittsburgh-based Highmark will start a bundled-payment program aimed at paying for “value” instead of for the number of procedures in cancer care, reports the Pittsburgh Post-Gazette.
The insurer’s new bundled-payment option includes 19 cancers treated with medication as well as radiation treatment for breast cancer. Instead of requiring physician to obtain pre-authorization for care, Highmark pays them a lump sum that it negotiates individually with each doctor based on past payments to that provider.
“They can treat the patient as they see appropriate because the health plan is stepping out of the middle,” Virginia Calega, Highmark’s vice president of medical management and policy, told the newspaper.
Tom Pellathy, senior vice president of product network and reimbursement at Highmark, said that more physicians have applied to participate in the bundled-payment initiative than the insurer can now accommodate.
Providers in the program are required to use National Comprehensive Cancer Care Network treatment guidelines, but they can use their discretion in how those guidelines are used, Mr. Pellathy added.
The initiative is a part of a partnership with Allegheny Health Network and Johns Hopkins Kimmel Cancer Center, called the Highmark Cancer Collaborative. Highmark’s regional rival, UPMC Health Plan, wants to start its own bundled-payment cancer-care initiative later this year.