Highmark, Humana, Horizon's payment models generate savings: 3 results

Morgan Haefner - Print  | 

Highmark, Humana and Horizon Blue Cross Blue Shield of New Jersey recently published positive results from their value-based reimbursement programs with providers. 

Each saw savings under their models, as well as improvements in quality metrics like hospital readmissions, health screenings and emergency department use.

Three results shared by the payers: 

1. Highmark has avoided more than $1 billion in costs through its value-based reimbursement program for primary care physicians. Claims data show that the insurer's True Performance value-based reimbursement program saved $1.1 billion in healthcare costs. The savings were related to emergency department visits and hospitalizations, and were generated from 2017-19.

2. Humana estimates in the past year, its value-based programs saved $4 billion in healthcare expenses that would have been recorded under fee-for-service models. Members receiving care from physicians in Humana's value-based arrangements spent 211,000 fewer days in the hospital and less time seeking care in emergency rooms. Hospital admissions were 29.2 percent lower, and ED visits were down 10.3 percent.

3. Morristown, N.J.-based Atlantic Health System and Horizon Blue Cross Blue Shield of New Jersey said their shared accountability program is working and has lowered costs by 5 percent in its first year. Under the program, Horizon ties its reimbursement directly to clinical outcome and cost goals rather than patient volumes. The organizations share financial accountability for the health, outcomes and total cost of care for a population of patients. Atlantic Health and Horizon said their program has reduced unnecessary hospitalizations by 9 percent.

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