Highmark Inc.’s patient-centered medical home program shows positive results, improves patient care, reaches milestone 1 million members

 Highmark Inc.'s Patient-Centered Medical Home (PCMH) program, which launched in October 2012, is showing positive results with statistical improvements in patient care, according to company data.

Highmark's PCMH data, obtained from a sample of more than 152,000 members in western and central Pennsylvania from physicians completing their second year in the program, implies that the quality and efficiency of care that patients receive has improved significantly since the programs were implemented:

  • Emergency room utilization is lower than the market by about 16 percent (adult care), 14 percent (Medicare Advantage) and 13 percent (pediatric care).
  • Readmission rates for commercial and Medicare Advantage members were lower than comparative market rates by 1 and 2 percent, respectively.
  • Prescription drug use is nearly 7 percent lower than the market, and stable for adult care, while the market trend is increasing by about 2 percent. Similarly, prescription drug use for Medicare Advantage members is decreasing by nearly 7 percent compared to market, with both the group and the market are trending slightly upwards at about 1.5 percent.
  • Inpatient surgical utilization is 12 percent lower (adult care) and 9 percent lower (Medicare Advantage) than the market.
  • Inpatient medical utilization for Medicare Advantage members is lower than the market by 25 percent.
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