Highmark programs help members manage chronic conditions
Monday, October 17, 2022
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.”
About Highmark Inc. One of America's leading health insurance organizations and an independent licensee of the Blue Cross Blue Shield Association, Highmark Inc. (the Health Plan) and its affiliated health plans (collectively, the Health Plans) work passionately to deliver high-quality, accessible, understandable, and affordable experiences, outcomes, and solutions to customers. As the fourth-largest overall Blue Cross Blue Shield-affiliated organization, Highmark Inc. and its Blue-branded affiliates proudly cover the insurance needs of approximately 6.8 million members in Pennsylvania, Delaware, New York and West Virginia. Its diversified businesses serve group customer and individual needs across the United States through dental insurance and other related businesses. For more information, visit www.highmark.com
All references to “Highmark” in this document are references to the Highmark company that is providing the member’s health benefits or health benefit administration and/or to one or more of its affiliated Blue companies.
This website is operated by Highmark, Inc. and is not the Health Insurance Marketplace website. It also does not display all Qualified Health Plans available through the Health Insurance Marketplace website. To see all available Qualified Health Plan options, go to the Health Insurance Marketplace website at HealthCare.gov.
Highmark Blue Cross Blue Shield or Highmark Blue Shield are Medicare Advantage HMO, PPO, and/or Part D plans with a Medicare contract. Enrollment in these plans depends on contract renewal.
®Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Benefits and/or benefit administration may be provided by or through the following entities, which are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Choice Company, Highmark Health Insurance Company, Highmark Coverage Advantage Inc., Highmark Benefits Group Inc., First Priority Health, First Priority Life or Highmark Senior Health Company. Central and Southeastern PA: Highmark Inc. d/b/a Highmark Blue Shield, Highmark Benefits Group Inc., Highmark Health Insurance Company, Highmark Choice Company or Highmark Senior Health Company.
PA: Your plan may not cover all your health care expenses. Read your plan materials carefully to determine which health care services are covered. For more information, call the number on the back of your member ID card or, if not a member, call 866-459-4418.
Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield.
West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield, Highmark Health Insurance Company or Highmark Senior Solutions Company. Visit our website to view the Access Plan required by the Health Benefit Plan Network Access and Adequacy Act. You may also request a copy by contacting us at the number on the back of your ID card.
Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield.
Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield.
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