Highmark’s True Performance program nears $2.5 billion in avoided costs

PITTSBURGH (July 26, 2022) – Highmark Inc.’s True Performance value-based reimbursement program for Primary Care Physicians (PCPs) has achieved nearly $2.5 billion in avoided cost savings 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 2021, Highmark members seeing a PCP in the True Performance program had lower ED utilization than those not in the program, with potentially avoided costs of $73 million. Members seeing a True Performance PCP also had lower inpatient hospital admissions than those not in the program, with potentially avoided costs of $621.5 million. These numbers were slightly lower than 2020, when Highmark member utilization of care was lower overall due to the pandemic.

“The True Performance program is an innovative way for Highmark to work with and incentivize providers to deliver the right care at the right time and in the most appropriate setting,” said Kavin Robertson, vice president of provider contracting and relations for Highmark. “This means that our members are getting high-value care, and the numbers show that we are also reducing costs.” 

Highmark’s True Performance program also helps ensure that PCPs are meeting nationally-recognized quality measures such as giving recommended immunizations, appropriate drug therapy for patients with chronic diseases, cancer screenings and annual wellness exams.

“This helps to ensure that our members are getting the preventive care and care coordination that helps them stay healthy and avoid more costly care later,” Robertson said.

The True Performance program also aligns with Highmark’s strategy of high performance networks and health insurance products that, together, help lower customers’ total cost of care, Robertson said.

Approximately 86 percent of all eligible PCPs in Highmark’s service areas participate in True Performance – that’s more than 12,000 participating physicians from more than 2,100 practices.

There are 2 million Highmark members currently seeing a PCP that is participating in the True Performance program.