New Health Care Solutions that Work Better for Everyone

Our Pay-for-Value programs — like Quality Blue — are changing how Highmark pays for care and reimburses doctors and hospitals.

At Highmark, we know you want a voice in decisions about your health care.

That’s why we’re working with doctors, hospitals and health service providers to develop new care delivery programs that place the patient at the center, and reward doctors for better results. These are known Pay-for-Value programs.

Pay-for-Value programs encourage cost efficiency and better treatment results.

  • They put patients at the center of coordinated care.
  • They focus on increased communication – both with you and your doctors, and among your various health care providers.
  • The goal is to deliver the right care, in the right place at the right time – without sacrificing quality.

With Pay-for-Value programs, a hospital or doctor’s reimbursement is tied to success in specific efforts to improve patient care. This has already resulted in:

  • Less duplication of services, better compliance and more patient follow-up.
  • Improvements to lower costs, increase education and improve the patient experience.

New physician-based models of care — Patient-Centered Medical Homes and Accountable Care Organizations — are using and expanding on the Pay-for-Value concept.

What’s a Patient-Centered Medical Home (PCMH)?

The patient-centered medical home is a new health care model.

It focuses on continuous coordination of a patient’s health needs, with the primary doctor’s office as the central hub or “home”. It helps people with a medical condition manage their full spectrum of care. In pilot projects across the country, the PCMH model has produced lower costs while improving treatment results.

What’s an Accountable Care Organization (ACO)?

An Accountable Care Organization is a group of doctors, hospitals and service providers that coordinate and personalize the health needs of the patient.

This fast-growing new payment and delivery model is designed to improve health care and lower costs. ACOs aim to personalize, simplify and coordinate patient care.

More than 500 ACOs are now being funded throughout the U.S., by either the public or private sector or both sectors. Opportunities exist for ACOs to reduce unnecessary hospital admissions and preventable readmissions, eliminate unnecessary emergency department visits, improve transitions in care, reduce the need for office visit–based care, and improve at-home care using new home diagnostic and treatment technologies