Highmark launched the True Performance program for eligible PCPs on Jan. 1, 2017. The new value-based program replaced all of Highmark’s primary care pay-for-value programs.
True Performance is designed to improve the quality of health care delivered to our members while working to reduce the overall cost of their health care. True Performance rewards participating PCPs for providing better outcomes to our members instead of the quantity of care.
True Performance shifts providers from volume-based payment methods to reimbursement related to quality and total cost-of-care outcomes. True Performance ties compensation to results by focusing on positive outcomes.
PCPs need to meet certain quality and cost measures to earn a reimbursement incentive. Patients should receive certain preventive and treatment services, such as childhood immunizations, appropriate drug therapy for chronic diseases, cancer screenings, and annual wellness exams — all key to keeping patients healthier. This helps our members avoid more costly care later.
Amy Fahrenkopf, MD, MPH, medical director and vice president of Market Transformation, noted that the program “aligns the incentives of both Highmark and the physician” to deliver the right care at the proper price.
Another positive aspect of this program for both members and PCPs is a monthly care coordination payment per patient that PCPs receive. PCPs invest this money to improve patient convenience, such as offering appointments outside of traditional office hours, hiring staff members to call and check on patients, and other patient-focused approaches.
As the health care industry becomes more complex, Highmark is taking steps toward more simplicity for PCPs and our members through True Performance.
