Highmark programs help members manage chronic conditions

CAMP HILL, Pa. (October 17, 2022) – Most people don’t realize it, but health insurance companies offer many programs to help their members get and stay healthy, or to better manage chronic conditions such as diabetes or heart disease. The programs are typically free for members and help reduce overall health care costs.

Suzanne Davis, care management lead with Penn State Health St. Joseph Medical Center, knows this well.

When patients at St. Joseph Medical Center are discharged, many are complex cases requiring specialized post-discharge care. Many patients also have co-morbidities and are at a higher risk for re-admission. In her role, Davis helps those patients get the appropriate care after leaving the hospital.

“What I have seen in many cases is that patients are going home, but they may not be in the state of mind to fully understand or remember discharge instructions,” said Davis. “That’s why, in my experience, having some help with post-discharge care is really important.”

So important, in fact, that Davis often refers patients to care and disease management programs offered by the patient’s insurance company.

“Highmark has some of the most comprehensive programs I’ve seen,” said Davis. “They offer a lot of different options, and the Care Management and Disease Management teams really take the time to make sure patients are getting the care they need.”

According to Highmark, Disease management programs cover the most common health conditions, including asthma, coronary artery disease (CAD), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, musculoskeletal pain, metabolic syndrome and behavioral health. A multidisciplinary team helps members engage in the behavior change process needed to better manage their specific condition(s) and overall health. Care Management programs assist members in managing their health, including prevention of hospital admission or readmission, ER visits, a shift of a procedure or service to a lower-cost and higher-quality site of care, reduction in the member’s spend on pharmacy and referral to hospice.

Highmark says it is already seeing early results with referrals to the programs.

In fact, Highmark has seen more than 100 referrals in the last year to its care and disease management programs from Penn State Health St. Joseph Medical Center alone, with cost savings of approximately $130,000.

“Penn State Health St. Joseph Medical Center has been one of the early adopters of our referral programs,” said Benjamin T. Edelshain, MD, vice president of Clinical Engagement & Digital Innovation for Highmark Inc. “They are an example of how we want to work with more doctors to get our members into a care management program for better outcomes and lower costs.”