Lehigh Valley Business took a deep dive into current health care topics with the help of three area experts in this year’s Health Care Trends and Updates Virtual Panel Discussion.
The panel, held on May 23, covered the latest developments in health care from recent changes in telehealth services to medical malpractice and more.
The panel’s experts included: Dr. Timothy Law, chief medical officer and vice president of integrative care delivery at Highmark, Katherine Betz Kravitz, partner and health industry group chair at Barley Snyder and John J. Herman, CEO at Penn Medicine Lancaster General Health.
Questions covered the end of the COVID-19 public health emergency, current legislation in the works that could impact health care in the region and recent financial and staffing issues felt by providers.
The Health Care Trends and Updates Virtual Panel Discussion was sponsored by Barley Snyder and Highmark.
More people looking for Affordable Care Act insurance coverage are opting for better coverage this year.
Bill Tuthill, vice president of marketing for federal markets for Highmark, said expanded subsidies available through 2025 are making it more attractive for people to choose plans that offer lower or no deductibles than in previous years.
And, he said, more people aged 60-64 are looking for coverage because many have opted for early retirement.
Highmark membership in ACA plans has grown 200% since 2019, Tuthill said. “We launched new products which translated to growth.”
People shop on price and what it they get for it, he said. “Many are used to what they got when they were in an employer offered plan and want to keep those benefits.”
Tuthill said the high-water mark for ACA plans hit in about 2014 when the rates were rising 40% and companies were withdrawing for participation. A lot of people stopped shopping for them because of the price increases and increased deductibles.
From 2016 to 2019, things got even worse because premiums continued to rise when the government wasn’t paying some carriers. “Some pulled out of the market. We stayed in but narrowed our offerings until 2020 when we could put out a broad network plan competitively,” he said.
That worked because employer plans often offer broadband products where people have more choices for doctors and hospitals in network. “People were used to that and wanted to keep it,” he said.
“You may have looked before but look again. You might be surprised at what you see,” he suggested.
That’s because with the government subsidies, premiums are a little bit higher but significantly less than other goods. And most carriers are offering more broadband policies.
The expanded subsidies have brought premiums down from $250 a month to $150 or even $125, he said. “Those are lifesaving amounts and 90% of people qualify for the subsidies,” he said. “In fact, 50% to 60% of people are opting for plans with zero deductibles.”
Highmark has seen more people opting for gold plans, which cost more but offer zero deductibles. Tuthill said there are bronze, silver and gold plans. The tradeoff is price, he said.
Previously, Tuthill said a lot of people were “too rich” to qualify for subsidies, referring to people making $53,000. Now, with the limits lifted, people making $80,000 and up may qualify.
Tuthill said the rates and qualifications are all based on a mathematical formula based on income, family size and age. Eligibility is easy to check, he said. The information can be found on most insurance company sites or at Pennie. Com.
Health care providers supercharged their telemedicine offerings as a result of the pandemic—however, how those providers will be reimbursed for virtual care moving forward is in question.
Prior to the pandemic, most providers did not receive enough reimbursements from insurance companies to justify expanding their telehealth coverage.
That changed when the Centers for Medicare & Medical Services, a federal agency that oversees Medicare and Medicaid programs across the country, introduced leniencies on HIPPA requirements on video software and broadened access to Medicare telehealth services.
Third party payers followed suit by expanding their telehealth service coverage, offering advanced payments to independent health care providers and waiving fees for members using virtual care.
Coverage that was previously based on the discretion of insurance companies, has become common across insurers, said Andy Carter, president and CEO of the Hospital Association of Pennsylvania (HAP).
“The number one impediment to telehealth expansion was that there was no payment model that you could get return on your investment because a lot of insurers wouldn’t pay for telehealth consults or appointments,” said Carter. “COVID changed that dramatically, where immediately public payers and private payers were paying for it across the board.”
In a 2022 report on national survey trends in telehealth use, researchers with the US Office of Health Policy noted that from March to April 2020, telehealth use skyrocketed across the country from 1% to 80% in “places where the pandemic prevalence was high.”
Today, patient usage of telehealth is significantly down from the days of quarantine, with the report finding that percentage had dropped to around 20% among adult respondents to a survey given between Sept. 29 and Oct. 11, 2021.
Providers see telehealth usage remaining much higher than pre-pandemic levels with the focus now turning to how providers and insurers can work together to standardize telehealth.
Standardizing telehealth
HAP has spent years trying to standardize telehealth protocols and practices, particularly when it comes to reimbursing providers for telehealth services.
Their most recent effort on that front has been backing Senate Bill 705, legislation that would require insurers to pay providers no matter if that provider is in that insurers’ network.
Carter said that in the past, the association supported bills that would provide parity between in-person and virtual care, meaning that payers would need to reimburse providers equally for either service, but the association has now agreed to leave pricing to individual payers and providers.
“We argue that standardization is hugely important,” said Carter. “Insurance is already complicated enough and a patient’s access to care through telehealth should not be a lottery. Parity was a nonstarter for our friends in the insurance community. We agreed to new language as an alternative.”
HAP is also currently in support of House Bill 2419, which would allow for more flexibility for the state to allow providers to offer mental health services through telehealth permanently.
House Bill 2419 has been passed in the House and is currently awaiting consideration in the Senate.
Pennsylvania’s COVID-era waivers that explicitly authorized telehealth services to expand during the pandemic will expire this October.
The waivers were set to expire at the End of June and were extended by the General Assembly on June 30.
The waivers expand access to telehealth services, increase vaccine access, allow hospitals to quickly adapt to emergencies by altering space as needed for influxes of patients, and ease regulatory barriers to clinician licensing.
Pennsylvania does not have any statutes that will prohibit the practice of telemedicine after the waivers expire but payers will be able to stop reimbursing for telehealth.
“Absent the current COVID driven waivers and flexibilities, we won’t sustain telehealth the way we did before COVID,” said Carter. “It’s not supposed to go away. People got used to it.”
Providing care in the virtual space
In the two years since providers have embraced telehealth, virtual care has had a massive impact on how the industry cares for patients.
Providers are now looking at how things like wearable technology and remote patient monitoring can keep tabs on patient health between visits, said Christopher LaCoe, vice president of virtual health at Penn State Health.
“We’ve moved to the point where we have all these opportunities to do checkups for diabetes. We might be able to do that stuff here and then send (the diabetic patient) to the eye doctor and not make them drive to our office,” said LaCoe, adding that educators are now taking telehealth services into consideration when they teach incoming providers. “Medical schools are putting this in their curriculum. They used to say you need to see diabetic (patients) every three months and now they say once a year.”
LaCoe, credited the waivers, calling the changes that happened to telehealth the pandemic’s “silver lining.”
Pittsburgh-based Highmark Health was early to the market on allowing telehealth for its providers, but prior to the pandemic, providers had little guidance on what that should look like, said Dr. Tim Law, vice president and executive medical director at Highmark.
“Highmark said you can do telehealth, but we won’t tell you how to do it—it wasn’t front and center,” said Law, noting that changed quickly during the pandemic. “We put together a virtual care playbook. Five years ago, I don’t think anyone would have thought of doing this. It includes where to find supplies, how to access Bluetooth technology so you can do remote patient monitoring and we show them what states allow providers to work across state borders.”
Highmark provides parity for its covered providers using telehealth with some of the states the payer operates in mandating it.
However, even though some insurers are ahead of the curve with how they support and pay for telehealth with their covered providers, providers outside of a network may find themselves without telehealth reimbursements, said Carter.
“Some insurers will say we provide telehealth to our covered lives. It’s only to the telehealth providers they’ve enrolled in their network,” said Carter. “That’s a model that leaves a lot of people without access to their preferred provider. Someone they know and trust.”
Highmark Health is working with a Pittsburgh-based health care technology startup to streamline member access to prescription drugs from specialty pharmacies.
Free Market Health, a cloud-based marketplace created to make it easier for insurers to authorize specialty medications to the pharmacy, and ultimately the patient, announced that it has raised $13.5 million in Series A Funding.
Highmark’s capital investment arm, Highmark Ventures, was one of a number of companies, including 653 Investment Partners and Alta Partners, to support the funding round.
Highmark has worked with Free Market Health’s market platform to remove pain points in the specialty pharmacy process, said Sarah Marche, senior vice president of pharmacy services for Highmark Inc.
“Our collaboration with Free Market Health means that Highmark members will enjoy quicker access to prescription drugs for chronic, high-cost health conditions, from specialty pharmacies tailored to serve their particular condition,” Marche said in a press release. “Working with Free Market Health advances our goal of transforming the pharmacy experience for our members and ensuring they have access to proven, affordable prescription drugs that help them be at their best.”
Specialty drugs make up just under half of Highmark’s $5 billion in annual drug spending, while specialty drugs make up less than 1% of the insurer’s claim volume, according to Marche.
“A very small percentage is driving a large percentage of our spend,” she said, adding that Highmark is currently collecting data to see what savings it can see under the platform. “We are not at the point of having a full savings report.”
Free Market was founded in 2019 with the goal of balancing the cost of care and the value that care provides. The company wrote in its release that it has a year of full scale operating under its belt and in that year, it has facilitated a match of thousands of specialty medication referrals and has hundreds of millions of dollars in specialty medication spend under management.
“Until now, no model seamlessly matched patients to the specialty pharmacy best suited for their care needs, let alone enabled the type of value orientation under a market-driven and dynamic reimbursement framework,” said Pete Hudson, managing director at Alta Partners, a health care venture capital firm. “Free Market Health sits at the intersection of price, value, and efficiency, for the ultimate benefit of the patient.”
An Allentown firm is bridging the gap to bring neurodivergent people into mainstream jobs, lifting their ability to make a living and offering companies a whole new pool of workers.
Anthony Pacilio, vice president, CAI Neurodiverse Solutions, PHOTO/PROVIDED –
CAI Neurodiverse Solutions, 1390 Ridgeview Drive, Allentown, places neurodivergent people with companies looking to diversify their workforce.
Neurodivergent people include those with autism, dyslexia, ADHD and other neurological differences, explained Anthony Pacilio, vice president of CAI Neurodiverse Solutions.
Pacilio, who worked for JP Morgan Chase when the company created the Global Autism at Work Initiative, found that he could fulfill something he had promised to do after making a friend on the autism spectrum years ago.
“When I saw that [this person] was bullied by his peers and others, I promised I would do something in my life that would make things better,” Pacilio said. “He was talented in graphic design and art, but it was hard for him to get through school.”
While at JP Morgan Chase in 2014, Pacilio jumped at the opportunity to work with companies to employ neurodivergent people.
“I mean, why couldn’t we have done this 20 years ago?” he asked.
It is estimated that over 1 billion individuals identify as being neurodivergent.
It’s also estimated that unemployment for neurodivergent adults runs at least as high as 30 – 40%, which is three times the rate for people with physical disabilities, and eight times the rate for people without disabilities, according to The Center for Neurodiversity & Employment Innovation, University of Connecticut.
Pacilio joined CAI, a global technology services firm, when they started CAI Neurodiverse Solutions, which is designed to bring the untapped talent pool of individuals with neurological differences into the workforce.
“Several years ago, companies started looking for people who were different than [the norm],” he said. “They wanted people who look at things differently and get different solutions.”
The companies will tell Pacilio what their needs are, and he will match clients to the position. But that’s just the start.
Part of his job is to educate the companies about interviewing techniques, integrating the clients into the mainstream workforce and building the employee’s confidence.
He also works with potential employees on how to interview and interact with the company they will potentially work for.
“We have Talent Discovery Sessions where we teach soft skills, time management, and what employer expectations are,” he said. “These are entry level jobs, but they often lead to greater things.”
Pacilio said that, over the past year-and-a-half, the demand for neurodivergent workers has increased 38%.
Melissa Stafanyszya, IT director at Highmark’s Pittsburgh office, works with 66 neurodivergent employees throughout Highmark’s network. Seven of those are located in Lehigh Valley.
“We started the program in 2018,” she said. “We use CAI for staff augmentation and employ many of them permanently.”
That’s because they become such a vital part of the teams they work with, she said.
Stafanyszya said research shows that people on the autism spectrum are indeed underemployed.
“We have some with master’s degrees that couldn’t find work and ended up working in movie theaters or grocery stores,” she said.
One of the problems neurodivergent people face is the interview process.
“It can be really hard, especially if it’s a panel interview,” she said.
With the help of CAI, Highmark will do on-the-job interviewing to see how they do in an office setting, or in the case recently [the past two years], remotely.
“I’m a sponsor of the work program,” Stafanyszya said. “The first group was under me, and we learned a lot from them.”
Many of those first employees would be tasked with putting information into the system. As their confidence grew, so did their ability to move into other jobs.
CAI does all the screening and recommends people for the positions Highmark has. They are contracted for a year, but the experience has been so positive, Stafanyszya said she tries to keep them on as full Highmark employees.
“We’ve had a few that came in very shy,” she said. “They wouldn’t be customer facing at first, but over time, they wanted to be. We have one gentleman who didn’t want any interaction at first. Now, he is running meetings alone. He loves being in front of people.
“It took about a year. He started doing small parts of meetings like taking notes or reviewing notes. I’m so proud of him.”
While many neurodivergent people are attracted to math related fields, Stafanyszya said the list of jobs they hold within Highmark is “impressive.”
“I love being able to watch them accomplish what they thought they couldn’t,” she said. “We mentor them and they become mentors. They are very loyal and so dedicated to doing a good job.”
As they learn, they are able to chase higher salaries and build resumes to get better jobs, Stafanyszya said.
“They find a team and love the people on it,” she said. “Then they grow their skill set so the retention rate is really high.”
Pacilio loves hearing this.
“This is a big thing,” he said. “Parents of neurodivergent kids are always asking what they are going to do with then when they get out of school. Neurdivergent kids have 504s and IEPs, [learning disability documents]. Colleges didn’t used to have them, but most do now.”
The company has researched and set up training to overcome the obstacles that used to stand in the way.
“I have depression and social anxiety myself,” Pacilio said. “The best part of my job is I can relate.”
The program teaches people what opportunities they have and shows companies the talents they have, he said.
“It allows people to be independent. Productivity aside, that is what makes me get up every day.”
Brian Rinker is the market president for the Eastern Pennsylvania Region for Highmark Blue Cross Blue Shield, based in Camp Hill & Wilkes-Barre.
He is responsible for coordination and support of Highmark’s business objectives and advocacy with key stakeholders.
LVB: Covid-19 has brought about changes in health care insurance. What are some of the big changes?
Rinker: One of the biggest changes we saw during the pandemic was the increase in usage and adoption of telemedicine.
At the beginning of the pandemic last year, Highmark expanded coverage for telehealth services to all members and waived cost-sharing (deductibles, coinsurance and copayments) on all covered telehealth services from contracted vendors and providers.
However, as restrictions are being lifted and more and more members are able to schedule in-person medical appointments, the cost-sharing waiver for in-network telehealth visits will expire as planned on June 30.
Throughout the pandemic, our members have really taken to telemedicine and the option to receive care virtually.
In fact, utilization of telehealth services by Highmark members during the pandemic increased by more than 3,400 percent and more than 3.4 million telehealth services were accessed by the end of 2020 alone.
LVB: What are some of the other trends in health care insurance?
Rinker: One trend we are seeing now is insurers working to help get not just their members, but everyone, vaccinated.
At Highmark, we are working with many partners to ensure that vulnerable populations are being vaccinating and learning that they should not be hesitant about getting the vaccine.
Highmark has joined with other Blue Plans for the Rally for Recovery Commitment to protect employees, encourage COVID-19 vaccinations and educate staff and local communities on ways to mitigate the spread of the virus. The pledge was launched in March 2021 by the federal government and business leaders.
We also joined the Vaccine Community Connects pilot program with AHIP, BCBSA and the White House to vaccinate 2 million seniors, with a focus on people living in the most at-risk vulnerable and underserved areas, including African American and Hispanic communities.
And we are a main sponsor with Latino Connection on several ongoing vaccination events serving minority and vulnerable populations across Pennsylvania.
And we have also partnered with Rite Aid to deliver 3,000 COVID vaccines to vulnerable populations (mostly seniors) in western and central PA at our Highmark Direct stores.
LVB:· How do you help employers navigate the changing health insurance landscape?
Rinker: Most employers utilize brokers who know health care and who can use their expertise to help the employer navigate the complexities of the health care landscape.
As an insurer, we can help customers by helping their employees better understand their bills, their benefits, and the cost of their care. Our transparency tools provide members with the information they need to make smart decisions about their health care and health care spending. This makes cost and quality not only transparent but meaningful; helping customers and their employees make educated choices when deciding on medical care.
These tools include:
A care cost estimator tool that allows members to shop and compare costs on common surgeries, diagnostic procedures, and office visits. The tool calculates what portion members will have to pay for medical care or procedures based on their plan and benefits.
A “Find a Doctor” tool that allows members to search for a local provider. Members can view a physician’s medical training, board certifications, professional recognitions, and practice details and compare up to three physicians side by side.
A Doctor Match tool also allows members to search for a doctor that meets their personal preferences, such as a doctor who likes to spend more time with patients or a doctor sensitive to cultural differences.
LVB: What are some developments in health care insurance that you see on the horizon?
Rinker: What we are focused on at Highmark is creating real value for our customers and members. This means working for customers and members to manage costs, manage quality of care as well as quality of health, and to create a remarkable member experience.
As an example, for the last several years we have been moving toward value-based reimbursement, which pays providers more when our members are healthier and have better outcomes.
And we are seeing results through our True Performance program. Our claims data for years 2017, 2018 and 2019 (2020 is not yet available) has shown that the program has helped to avoid a total of $1.09 billion in health care costs from Emergency Department (ED) visits and hospital admissions.
We are also implementing high-performance networks and products with like-minded providers that offer our customers and members the highest value.
Together, these initiatives are helping to lower our customers’ total cost of care.
An independent pharmacy solution startup funded by five Blue Cross Blue Shield plans is expected to improve medication affordability for patients across the state.
Pittsburgh-based Highmark Inc. and Philadelphia-based Independence Blue Cross announced on Tuesday that they are part of a group of Blue Cross Blue Shield plans funding Evio, a Denver-based startup meant to use data from its five founding plans to lessen the cost of drugs and improve clinical outcomes.
“Ourselves and our sister Blues, we understand that we need to continue to innovate and drive better value for our customers,” said Corey DeLuca, vice president of clinical and specialty pharmacy services at Highmark. “Each of our plans has done a great job to look at ways to improve health outcomes. We acknowledge that there is opportunity when you have a company like Evio to really complement some of the transformative work we are already doing independently and innovate.”
The five plans funding the venture are Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan, Blue Shield of California, Highmark and Independence Blue Cross. They account for over 20 million members across the country.
Using data from the five Blue plans, Evio plans to look at how each drug performs for patients, develop partnerships among pharmaceutical and other health care businesses and enhance outcomes-based contracting in the pharmacy space.
“Patient frustration with the system and disparities in health equity are higher than ever. And, the price of virtually every prescription drug is roughly double by the time a patient pays for it at the pharmacy counter than it was when the drug was shipped from its manufacturing site — without transparent benefits to the patient,” said Hank Schlissberg, Evio’s president and CEO.
The new venture is one of many programs that area Blue Cross Blue Shield plans have joined to limit the cost of medications. Last year, Highmark, Independence and Harrisburg-based Capital Blue Cross joined 15 other Blue organizations in founding nonprofit generic drug manufacturer Civica Rx.
“Evio builds upon our long-standing collaborations and innovative work with customers, health care providers and other important stakeholders in the prescription drug value chain to help members more easily access the medications they need, when and where they need them, at a cost they can afford,” said Gregory Deavens, Independence Blue Cross president and CEO.
The panel, clockwise from top left, Peter Meredith, interim editor of Lehigh Valley Business; Stephanie A. Koenig, attorney for Fitzpatrick Lentz & Bubba; Carol Michaels, Populytics; and John Lufburrow of Highmark, discuss returning to the office in a post-pandemic economy during an LVB webinar.
How do you position your business in the post-pandemic economy? A number of local experts answered that question during a webinar hosted by Lehigh Valley Business.
Carol Michaels, an administrator with Populytics, said there are signs that better days are ahead.
“My promising sign is that a significant number of Americans are getting vaccinated. About half of the U.S. population has been vaccinated up until this point,” she said. “The number that we’re shooting for to get herd immunity is 75% or even 80%.”
“From an economic perspective there are a lot of indicators that we’re making an economic recovery and we’re moving in the right direction,” added John Lufburrow of Highmark. “We have clients that are starting to hire people. Some employers are even having trouble filling vacancies that were created during the pandemic.”
But, though there are hopeful signs, there are concerns about how to return to work safely, said Stephanie A. Koenig, of Fitzpatrick Lentz & Bubba. Employers want to bring their workers back in an economically sustainable way, but also in a way that will allow employees to feel safe.
People and businesses weren’t prepared for the impact of COVID 19 or its duration, Michaels said. That meant many changes and adapting to situations over the past year, and that’s been stressful for employees.
“They’ve had to continue to cope and re-cope throughout the year, she said. “Now, coming back to the office post-COVID, whatever your office looks like, will be another adjustment and employers will need to recognize that it’s another change and it’s going to take time to adjust to that. Mental health… and wellbeing absolutely have to be on our radar.”
Koenig is stressing to her clients the importance of communication. “That may mean updating your employee policies as a result,” she said. Things have clearly changed and employers need to be clear about what those changes have been and how they affect company policy. Changes made to make the workplace safer need to be clearly explained to ease employee anxiety about coming back.
One strategy Koenig has seen employers do to increase employee comfort levels is bringing workers on a 50-50 basis – half works in the office one day, and the other half the next. Doing so, she said, gives everyone more space.
Every business is going to be different said Lufburrow. “Don’t benchmark yourself over what someone else is doing. Do what’s best for your employees and your business,” he said. There are many good reasons for companies to want their staff back in the office.
“It’s very difficult to onboard new employees virtually,” he said. “They can get lost in the system. They won’t feel connected. They won’t have that assimilation into your culture.”
Even before the pandemic he said there were disadvantages to being a remote worker, especially if that individual wants to move up in the company. He cited a University of California Berkley study that showed people that onsite employees at Silicon Valley companies were three times more likely to get promoted as those working offsite.
Companies also need to keep track of changing government regulations
“It seems like each week there’s a roll out of a new government measure. They’re not always well thought out from a court perspective,” said Koenig. She said, for example, some will talk about leave, but will give no definition.” Her office is still getting a lot of questions about vaccinations, but her answers are not one size fits all. “Do we require it? Do we recommend it?”
Answers are going to be different for large and small businesses. Her advice is to take the temperature of the workforce. How do they feel about it?
Other things to consider are whether most of your workers are in the office or working remotely. Or are they Unionized?
Use assistance programs
Michaels said companies shouldn’t be afraid to tap into their employee assistance programs to help with strategies and to give employees a place to voice their concerns about returning to the workplace. She said paying attention to employee’s emotional health and wellbeing is going to be an important part of returning to the office.
She said now that companies know they can continue to work remotely how can they do that and help employees to thrive. For example, can staffers use that extra time they don’t spend commuting to and from work to get in a brisk morning walk?
One industry that is seeing a great deal of change is the health care, said Lufburrow. While telemedicine isn’t new, it became much more widely used during the pandemic as many people were hesitant to go to health care facilities. The popularity of telemedicine has remained even as the pandemic has eased. It can be a very efficient way to get the care that you need, he said.
Lasting changes
Koenig said the pandemic will have a lasting effect on the economy of the region. The pandemic has shown that people like to get things delivered to their home. From a commercial real estate perspective, the region is well positioned to tap into that demand. Because of that the warehousing and logistics industry is going to continue to grow.
There are advantages to the new way companies are working. The remote economy has blown up the talent pool that employers are used to, Lufburrow said. They are no longer limited to hiring people locally. While that means a great deal of the Lehigh Valley’s talent is getting poached by other areas, employers may also find that the perfect person to fill that job is in Florida and they can hire that individual to work remotely.
“In every area there’s a shortage of certain specialties,” he said. Remote access to talent can help ease that problem.
Highmark is extending its waiver on cost-sharing for both inpatient hospital care related to COVID-19 and telehealth visits for members of the Pittsburgh-based insurer to June 30, as opposed to the original end date of March 31.
Despite the growing numbers of vaccinated Americans, the country continues to remain in a public health emergency and there is still a need for COVID-19 related assistance, said Deborah Rice-Johnson, president and Chief Growth Officer at Highmark.
“We recognize that our members are still going to need treatment for COVID-19, and we want to make sure that they won’t have to worry about copays or coinsurance through the middle of the year,” she said.
Highmark members and Highmark Medicare Advantage members will not need to pay cost-sharing such as deductibles, coinsurance and copays when receiving inpatient hospital care for COVID-19 or when receiving either in or out-of-network telehealth care.
Highmark’s Medicare Advantage members will also see no copays for COVID related hospital admissions for the duration of the public health emergency and members will be able to receive COVID-19 vaccines free of charge.
Pennsylvania physicians that aren’t affiliated with a health care system are eligible for part of a $4 million grant fund through the Pennsylvania Medical Society (PAMED).
PAMED, along with PA Clinical Network and Highmark, announced on Monday that the organizations will be opening grant applications to support area physicians with services and projects to improve health care and make care more accessible in their communities.
Physicians must be PAMED members, engaged in the full-time patient-facing practice of medicine and cannot be affiliated with a health system or hospital.
Primary care applicants are eligible to receive up to $15,000 and non-primary care applicants can receive up to $10,000. Physicians from the same practice can apply, with each practice able to receive up to $75,000 in funding.
“There is no one size fits all in Pennsylvania when it comes to physicians and support for independent physicians is truly important as they play a vital and significant role in our health care system,” said Dr. David S. Webster, vice president and executive medical director of Clinical Services at Highmark.
Applicants can use the funds on health care services for uninsured patients and those unable to pay for services, programs for the prevention and treatment of disease or injury and other services such as treatments for veterans.
Applications are open now on a first come first serve basis.
Dr. Jaan Sidorov, CEO and president of PAMED’s PA Clinical Network, said that the funds will go a long way to increase health care quality in the state. He added that PAMED’s physicians will be able to use the funds to educate patients and provide services outside of their offices.
“For example, persons with diabetes or high blood pressure can monitor or self-treat outside the clinic and we can tailor additional services for patients,” said Sidorov. “The technology can be used to monitor impact at a patient as well as public health level.”
The Pennsylvania Medical Society is a physician-led organization representing physicians and medical students throughout the state. Its subsidiary, Harrisburg-based PA Clinical Network, is an alliance of health care providers throughout the state that share knowledge, expertise and resources to reduce cost. Physicians don’t need to be members of PAMED to join PA Clinical.
Highmark members increased their use of telehealth services by 3,400% last year as a result of the COVID-19 pandemic.
Unable to access their local providers because of quarantine, more patients than ever had access to virtual care in 2020.
Pittsburgh-based Highmark has offered telehealth services to its members for many years, but for a majority of its members, 2020 was their first year that they needed it, said Dr. David Webster, vice president and executive medical director of clinical services at Highmark.
“Overall, by the end of 2020 we saw an increase in utilization of telehealth services by more than 3,400 percent over 2019 and more than 3.4 million telehealth services were accessed by our members,” said Webster.
In 2020, Highmark paid local doctors nearly $300 million for telehealth services, an increase of more than 8,000% over 2019, according to Webster.
Even after stay-at-home orders were lifted across the state, Highmark continued to see patients rely on telehealth to avoid the virus as well as long waiting times for appointments.
Throughout the year, the insurer saw 1.5 million claims for behavioral health services and 1.1 million claims for primary care services. 3.3 million of Highmark’s claims were for local doctors while 79,000 came from telehealth vendors such as Brightheart, American Well and Doctor on Demand.
“Highmark’s data also showed that women were more likely to utilize telehealth, and that members aged 30-39 were the most likely to access telehealth services, with 350 per 1,000 members in this age group utilizing telehealth services,” he said. “We also saw the largest number of telehealth claims among members aged 19 or younger.”
Since Highmark Inc. began offering its value-based reimbursement program for primary care physicians in 2017, the Pittsburgh-based insurer says it helped its members avoid more than $1 billion in emergency department visits and hospital admissions.
Highmark officials said its True Performance initiative, a program that rewards physicians for reaching nationally-recognized quality measures, cut costs in its first three years by encouraging providers to focus on quality rather than quantity of care.
“True Performance incentivizes primary-care physicians to deliver the right care at the right time and in the most appropriate setting, and that helps keep customers’ employees and our members healthier, which means fewer ED visits and hospital stays,” said Sean Burns, vice president of provider payment for Highmark.
Incentives for physicians are based on measures such as Highmark members receiving recommended immunizations, appropriate drug therapies for patients with chronic diseases and cancer screenings.
The $1.09 billion amount was based on claims data from 2017 to 2019. About 84% of all eligible primary care physicians in Highmark’s service areas participate in the program, accounting for nearly 11,000 physicians at more than 2,000 practices.
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