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Highmark Execs Detail ACO Transformation

Christopher Cheney, for HealthLeaders Media, May 13, 2014

Highmark, the Pennsylvania-
based integrated healthcare network, seeks to use ACOs and primary care medical homes to transform the way it does business.

One of the biggest Blue Cross Blue Shield carriers in the country says it is pushing the accountable care organization envelope.

Highmark Inc. has offered BCBS health plans for more than 75 years. A year ago, the Pittsburgh-based payer acquired the seven-hospital Allegheny Health Network, which helped make Highmark the third-largest integrated delivery network in the country.

Now the 5.2 million-member insurer with operations in Delaware, West Virginia, and Western Pennsylvania is banking on the ACO model to drive down costs in the seven-hospital network and spur development of a sprawling integrated healthcare delivery system.

In a phone interview last week, a pair of Highmark executives described the company's quest to transform the way the Blues does business. "We're trying to change our primary care model," said Mark Piasio MD, MBA, medical director at Highmark.

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Deborah Donovan, director of provider performance and innovation at Highmark, said merging payer and provider offers valuable opportunities for the partners to leverage each other's skills and resources.

"Payers have incredibly rich data sets that we haven't shared with providers; we haven't really needed to because of the focus on care [to the exclusion of cost in the fee-for-service system]," she said. "The holy grail is when we can link the rich claims data with the clinical data the providers have."

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