Highmark names chief investment officer

Highmark Health named John Orner senior vice president and chief investment officer. He replaces Dennis Cronin who plans to retire at the end of the year after more than 28 years in the position.

As chief investment officer, Orner will oversee the Treasury Services Division of Highmark Health, which will include investment activities and corporate insurance functions for all of the company’s entities.

He will also supervise debt issuance and monitoring activities for Highmark.

Orner has more than 30 years of treasury, business development, and investment experience, primarily with Blue Cross Blue Shield of Minnesota. He has served as the insurer’s vice president, treasurer, and chief investment officer since 2009, overseeing $4.5 billion of asset across a wide spectrum of portfolios, leading cash flow forecasting and cash management of over $13 billion in annual cash flows, and managing BCBSM organization-wide risk management.

He has an MBA from University of St. Thomas Opus College of Business in St. Paul, Minnesota and a bachelor’s degree in management from Cardinal Stritch University in Milwaukee, Wisconsin.

Highmark Medicare waives co-pays for COVID inpatient hospital care in 2021

In preparation for its Medicare product rollout for 2020, Highmark Health ensured that it had the infrastructure to allow all of its Medicare consumers the ability to receive care through telehealth.

That foresight proved beneficial for the Pittsburgh-based insurer when the pandemic made it nearly impossible for most Medicare-eligible patients to receive in-person physical care.

With the framework already set to pay providers for their telehealth services in place, Highmark waived all of the costs for telehealth for its Medicare customers during the pandemic to ease the transition away from physical care.

The system was only able to enact those changes in the same year thanks to a series of regulatory rollbacks from the Centers for Medicare and Medicaid Services.

For 2021, Highmark plans to continue to offer zero copay for all primary care visits, but will revert back to its previous cost-sharing amount with specialty care physicians, said Ellen Galardy, vice president of market strategy for Medicare markets at Highmark Health.

“Our strategy was to make sure that for COVID we covered all services,” said Galardy. “In 2020 we felt like we had to give a push to help people try telehealth for the first time. What we saw was almost all of that was primary care visits.”

Last week, Highmark revealed its Medicare Advantage products for next year. Galardy said the 2021 series of products were greatly affected by the pandemic, with Medicare-eligible customers having access to testing and vaccinations at no charge. The insurer also waived copay for inpatient hospitalizations related to COVID-19 for part of 2020 but will now be waiving copay for the entire year.

“With the advent of COVID, not only was Highmark one of the first to waive the cost of inpatient stays for COVID, we took steps early this spring to file for 2021 as well,” Galardy said. “We hoped that this would be behind us but we were proactive to make sure that our members didn’t need to worry if they found themselves in that situation.”

In anticipation for Medicare’s open enrollment period from October 15 to December 7, Galardy said Highmark has prepared its health care stores in Easton, Lancaster and Harrisburg to adhere to social distancing guidelines knowing that many of its customers feel more comfortable going to third-party locations rather than have a sales person come to their homes.

Galardy added that despite the preparations, many customers may decide to wait another year before choosing a Medicare product.

“Highmark is taking every bit of care to make (shopping in the COVID environment) safe and we are waiting to see if even more people will be looking or if they will delay shopping for a product for another year,” she said. “You see some people respond to COVID by sitting tight.”

Study shows poor health for millennials

Compared to the generation that came before them, millennials are more likely to be depressed, suffer from type 2 diabetes and abuse illicit substances.

That was the conclusion of a report analyzing data collected by the Blue Cross Blue Shield Association on the 55 million millennials insured by its members nationwide.

Those members, including Pittsburgh-based Highmark Blue Shield, are sharing the results with millennials in an effort to gather more information on the causes of poor health.

“With millennials on track to become the largest generation in the near future, it’s critical that they’re taking their health maintenance seriously,” said Dr. Vincent Nelson, vice president of medical affairs for the Chicago-based Association for 36 Blue Cross and Blue Shield insurers.

However, the report showed millennials are less likely to have a primary care physician, with 68 percent of millennials having a physician compared to 91 percent of Gen X-ers at a similar age. The data was taken from millennials aged 34 to 36 in 2017 and from Gen Xers at the same age in 2014. Millennials are those born between 1981 and 1996, while Generation X extends from the mid-1960s to 1980.

The Association is holding listening sessions across the country, with Highmark Blue Shield hosting the sessions in Pennsylvania. Independence Blue Cross hosted a session in Philadelphia in April and Highmark hosted a second this week at Highmark’s office in Cumberland County.

Highmark is looking to host more sessions in the coming months but has not announced where those will be.

About 25 millennials of various ages attended the Cumberland County event to talk about their relationship with health care. The attendees had mixed views on a number of topics, including telemedicine, with some millennials liking the ability to confer with a doctor through a video call, while others found it didn’t offer the same results as an in-person meeting.

Attendees also discussed the state of millennial health.

Marknoll Palisoc, 30, suggested that the high prevalence of major depression and substance use disorder could stem from a mix of millennials feeling more comfortable asking for help and of stress due to outside influences like social media.

“People are probably more open nowadays to come forward and seek help from a mental health professional. We actually see them more now, it’s more talked about,” Palisoc said. “We are also in a generation where social media is a huge thing. You have this sense of being criticized all the time so maybe that is causing more stress.”

Most of the attendees agreed they made infrequent visits to their physicians, but they showed interest in online tools that ease the process of shopping for health care.

“I want a good shopping tool for the things that are commodities for health care like labs and imaging,” said Christy Frownfelter, a millennial and director of integrated provider partnerships for Highmark Health.

The findings of the listening sessions and the report are expected to be presented at an event at the end of the year that will focus on how the health system as a whole can tackle the problem.

“We will be convening stakeholders across the health care spectrum to discuss what we learned in these sessions and we will come together to change the trajectory we are seeing,” said Pankti Pathak, a manager of Health of America, the name for a series of reports created by the Blue Cross Blue Shield Association.

The series relies on Blue Cross Blue Shield data to discover trends in health care, one being that millennials appeared to be less healthy than their generational predecessors.

“After seeing this trend from so many of our reports, we decided to take a deeper look into the population and what was going on,” Pathak said.

The report measured the prevalence of different health conditions among millennials and compared them to Gen-Xers. The report featured a list of the top 10 conditions that were most common among millenials.

Millennials had a higher prevalence than Gen-Xers  of the same age on eight of the 10 conditions, including: major depression (18 percent higher); substance-use disorder (12 percent higher); and type 2 diabetes (19 percent). The generations had the same prevalence for alcohol abuse.

In the Harrisburg-Carlisle metropolitan statistical area, a region defined by the U.S. Census as including Harrisburg, Carlisle, Lebanon and Hershey, millennial health was worse across the board.

Millennials in the region had a 44 percent higher  prevalence for major depression compared to their Gen X counterparts. They also had 12 percent higher prevalence for substance use disorders, 18 percent higher for alcohol use disorder and 26 percent higher for type 2 diabetes.

“With the analysis we found what the state of millennial health was,” Pathak said. “With the listening sessions we want to find why this is happening.”

Top court allows UPMC-Shapiro fight to continue

UPMC and Pennsylvania Attorney General Josh Shapiro are heading back to court in their battle over a consent decree requiring the Pittsburgh-based health network to take patients insured by Highmark Health.

The Pennsylvania Supreme Court on Tuesday reversed a lower court’s decision that would have ended the consent decree on schedule on June 30. Shapiro is fighting to have it extended indefinitely.

But the decision was not unanimous. The court ruled 4-3 in favor of Shapiro, finding fault with the reasoning of the Commonwealth Court. The ruling does not mean the decree will be extended, only that Commonwealth Court will have to rehear the case.

A date for a hearing has not been announced.

“As directed by the Supreme Court, my office will now make our case in Commonwealth Court on an expedited basis that modification of the end date is not just permitted — but necessary to ensure UPMC fulfills its role as a public charity and isn’t able to shun the very taxpayers whose tax dollars built their business,” Shapiro said in a statement.

UPMC was not immediately available to comment on the ruling.

The Supreme Court justices split over whether and to what extent the decree between UPMC and Highmark could be modified. The majority agreed it could and that, based on the decree’s language, there were no limits on how.

“Given the unbounded language of the Modification Provision, seasoned counsel likely foresaw, or should have foreseen, the possibility that significant alterations might be requested,” Justice David N. Wecht wrote for the majority.

In a dissenting opinion, Justice Max Baer said he agreed with the majority that Commonwealth Court ruled incorrectly, but that the decree’s modification clause should be limited. He wrote that changing the end date from June 30 to “indefinite” is not a modification.

“I conclude that the ‘modification’ sought by the Office of Attorney General is not a modification at all but, rather, an attempt to seek judicial intervention to eliminate the termination date and impose upon UPMC a permanent injunction requiring that it remain tethered to Highmark indefinitely,” Baer wrote.

The consent decree was reached in 2014 after UPMC and Highmark fell out over Highmark’s purchase of Allegheny Health System, a rival health system to UPMC. UPMC said it would stop accepting patients insured by Highmark. The consent decree created a five-year transition period.

Opioid addiction programs by health care providers see results

Dr. Sarah Kawasaki, director of addiction services at Penn State Health’s Pennsylvania Psychiatric Institute in Harrisburg, explains the steps that the system is taking to treat opioid addiction in the region during a press conference on Wednesday. (Photo: Ioannis Pashakis) –

Over-prescribing opioids have been targeted as a driving force behind the nation’s opioid addiction crisis. For the past year, two Pennsylvania health systems have taken efforts to slow the problem.

In their first year as a shared health care network, Highmark Health and Penn State Health, enacted a suite of programs in 2018 to fight the state’s ongoing opioid crisis.

Pittsburgh-based Highmark Health’s strategies helped overall opioid prescriptions drop by 15 percent for its insured members.

Those strategies include:

  • Working with providers to offer services like physical and occupational therapy to individuals who could manage their pain without opioids
  • Monitoring members’ prescribing patterns to identify unsafe use of the drugs
  • Linking those members with the correct treatment

Meanwhile, Penn State Health grew its Pennsylvania Coordinated Medication-Assisted Treatment program with a $750,000 grant from Highmark. The program helps the system provide medication like Suboxone and Methadone to treat patients with opioid addiction while also providing care to address both physical and mental health issues.

“Our approach (to treating opioid addiction) is focused on primary prevention, safe prescribing and management of pain, high quality and accessible addiction treatment and community support. You need all of those to make this work,” said Dan Onorato, executive vice president of corporate affairs for Highmark Health, at a news conference Wednesday.

Penn State Health CEO Dr. Craig Hillemeier said that the multi-faceted approach to reducing opioid abuse has worked in the past year because Highmark’s contributions have made the efforts more sustainable.

Other efforts between the two entities included nearly $500,000 donated toward community organizations and programs focused toward fighting opioid addiction in Pennsylvania and a program using Penn State Health Milton S. Hershey Medical Center’s pain specialists that guided more than 600 patients on the use of opioids in 2018.

“As individuals, we all know someone whose life has been upended by opioid addiction,” Hillemeier said. “As health care providers, we see the impact of this crisis every day in our emergency rooms, our psychiatric hospital, our outpatient practices and sadly, even our morgues.”

Penn State Health and Highmark Health’s actions are a part of a nationwide attempt to battle an epidemic that began in the health care space.

It’s an epidemic that Pennsylvania Attorney General Josh Shapiro said during a press conference Tuesday was caused partly by pharmaceutical company Purdue Pharma which he said deceived health care providers into pushing the use of opioids.

In a lawsuit filed in the Commonwealth Court of Pennsylvania, the office alleges that Purdue, the manufacturer of OxyContin, had approved its sales representatives to deceive doctors with information that claimed the drug wasn’t harmful to patients.

The suit alleges that representatives told doctors that if their patients were showing signs of addiction, it was a symptom that the patient was having continued pain and should be treated with more OxyContin.

“Purdue marketed to doctors a symptom they fabricated called pseudo addiction,” Shapiro said. “We allege that Purdue misrepresented their products as non-addictive and omitted scientific contrary evidence.”

Caesar DeLeo, vice president and executive medical director of strategic initiatives at Highmark, agreed that physicians were tricked into overprescribing medication and said that Highmark and Penn State Health’s programs are looking to fix the harm that was done.

“Physicians believed opioids were safe and effective and not addictive based on poor science funded by some of the companies,” DeLeo said. “We tried to eliminate pain by overprescribing and that was the wrong thing to do and now we have to reel this in.”