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Citing Cost Reductions, Highmark to Expand PCMH Initiative

John Commins, for HealthLeaders Media, January 24, 2013

The success of a year-long pilot program of patient centered medical homes has prompted Pittsburgh, PA-based Highmark Inc. to broadly expand the initiative in two states.

"Our goal is that in about a year from now 75% of all our doctors in our network will be part of a patient-centered medical home, and will be working effectively and efficiently amongst themselves as primary care physicians and with their specialist colleagues," Paul Kaplan, MD, senior vice president of provider strategy and integration at Highmark, told reporters at a teleconference Wednesday afternoon.

The PCMH model began in 2011 with 160 primary care physicians in 12 practices, covering about 45,000 Highmark members. Effective this month, the program will be expanded to include nearly 1,050 primary care physicians in 100 practices covering 171,000 Highmark members in Western and Central Pennsylvania and West Virginia, Highmark says.

Michael Fiaschetti, president of health markets at Highmark, told reporters that the pilot project saw a nearly 2% reduction in costs per member per month while traditional care delivery programs within Highmark saw cost increases. The demonstrated savings, he says, will serve as a catalyst to greatly expand the PCMH model in the coming years.

"Our goal a Highmark over the next three-to-five years is to transform the way we interact with physicians, hospitals and all healthcare providers," Fiaschetti told reporters. "We want to move from a pure or straight fee-for-service environment where we pay for volume and move to a pay-for-value environment. This is a foundation to that movement - the patient-center medical home is foundational to accountable care organizations or any other type of pay for value program that we do."

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