An Oral History of Highmark's Founding Role in CHIP

"We were definitely the template for how Pennsylvania set up what became the Children's Health Insurance Program," says Diana Kobus, Highmark CHIP program director.

It isn't often that you get to tell stories like this: how the scaling of a hyperlocal crisis response helped create a nationwide children's health safety net that two generations of women leaders at the same health plan have contributed to.

In an exclusive interview with HealthLeaders, Highmark's Diana Kobus provides an oral history of the central role that her plan—and her mother—played in establishing what would become the model for the federal Children's Health Insurance Program (CHIP).

"It was truly a labor of love to make this happen," says Kobus, Highmark's CHIP program director. "The community said, 'We see a need and we're going to fill it.'"

How it began

"[T]he CHIP program emerged from a grassroots, community-wide effort to provide care for kids following the collapse of the steel industry [in the early 1980s]."

That's the official history from the Highmark press release, which describes how the plan partnered with "more than 15,000 individuals, churches, unions, schools and other community organizations to raise funds and identify uninsured children." The result was The Caring Program for Children, a first-of-its-kind initiative to cover at-risk kids with no exclusions for pre-existing conditions.

Kobus adds texture to that history.

"The community approached us saying, 'We want to help and we've raised money. What can we do?' We're not really sure why they ended up focusing on healthcare, but we're really glad that they did."

The "we" was a local Presbyterian Church, Fox Chapel. Reverend John Galloway contacted Eugene Barone, president and CEO of what was then Blue Cross of Western Pennsylvania. Barone, in turn, worked with the plan's product team.

"The team found this huge gap in child primary care to create [The Caring Program for Children]." says Kobus. "My mother was part of the team that figured out what it could do and for what amount."

But Barone insisted they go further.

"Eugene said, 'It's got be cheaper,'" notes Kobus. "That's when we created the plan to match the donation dollar for dollar, and that's how it worked and for the first years of the program."

Everyone pitched in.

"We had community sponsors, like local submarine shops that would help five specific kids. They'd send their donation, we'd match it and there would be this whole team of people who would create invoices by hand to ensure we were applying the money to the correct children," says Kobus.

How it grew

"We took the learnings and successful model of The Caring Program and scaled it," noted Highmark Health Plan president Tom Doran in the CHIP press release.

That scaling would ultimately reach national proportions.

The Caring Program grew from a local Highmark effort to a coalition of more than 20 Blues plans. The effort allowed then-Pennsylvania legislator Allen Kukovich to advance State legislation that would eventually inspire the model for CHIP, signed into federal law in 1997. Today, CHIP covers more than seven million kids across the U.S. In Pennsylvania, the Highmark Healthy Kids CHIP covers more than 15,000 kids across 62 counties.

Kobus draws parallels between Pennsylvania's response to the children's healthcare crisis in the 1980s and the national COVID-19 response 40 years later.

"This is kind of like what we're seeing with the pandemic," she says. "There was already a health crisis and now these children had even more dire needs."

The current generation of CHIP leadership

Highmark CHIP continues to be collaborative and comprehensive. Highmark wants to keep it that way now that the end of the Public Health Emergency (PHE) has triggered a return to pre-pandemic operations.

"In mid-2022, when we were still unsure of when the PHE was ending, we created a cross-functional team for CHIP, ACA plans, and Medicaid—a kind of 'Who's on first' approach," says Kobus.

CHIP "redeterminations" are particularly unique in Pennsylvania. The program's unwinding isn't about eligibility redeterminations but resuming the required premium payments that Highmark suspended during the PHE.

"CHIP in Pennsylvania is awesome because there's no income ceiling. You just have to pay the premium," says Kobus. "The question became, 'How do we turn back on payment? When does that start? How do we make families whole? How do we work through these issues with them?'"

To answer these questions, Highmark extended its internal collaboration to the state level and the Department of Human Services Office of CHIP.

"They're very thoughtful about how we're going to ensure no disruption to families. It's definitely a partnership with the State."

Highmark works closely with Pennsylvania DHS in emerging areas as well. Per Kobus, this includes eliminating access barriers, leaning into telehealth, and bringing care into communities to address appointment wait times. Highmark's dental bus program is an example.

"Tried and true"

No matter the partner, Kobus identifies a key throughline in Highmark's approach to collaboration.

"Listening is still paramount to what we need to do. We've been listening to our communities and community-based organizations all this time." That time spans both her leadership and her mother's.

Returning to CHIP, Kobus notes: "It's really exciting that we have this program that has been tried and true for 30 years, helping families build a bright healthy future."

"That's really the mission of Highmark and that's what we were doing back in 1984," she adds. "Freeing families to live their best lives."