Highmark Health has earned attention as the largest integrated healthcare system created by an insurer rather than a provider network. Our affiliated companies serve nearly 50 million people nationwide. We have also created a fully integrated delivery and financing model in western Pennsylvania that connects coverage from Highmark Blue Cross Blue Shield and care from the Allegheny Health Network (AHN), which includes eight hospitals, 2,800 physicians, and numerous Health + Wellness pavilions, urgent care facilities, outpatient surgery centers, and other home- and community-based health services.
But the value of our integrated approach to healthcare is not limited to what we own in our western Pennsylvania service area. Whether it involves our affiliated companies or external partners like Johns Hopkins Medicine, we believe the healthcare enterprise of the future should be fundamentally collaborative and built around certain shared strategic priorities.
First, the primary focus must be the consumer. That can’t just be patient-centered care in hospitals. We must work together to get a 360-degree view of the entire healthcare journey and then, collaboratively, design coverage, care and related services that are more responsive to the real-life needs of today’s consumers.
Prioritizing Customer Value
Second, a value-based framework must replace old, volume-driven, fee-for-service models. That includes value-based reimbursement – but also prioritizing value creation for the customer. The first step in overcoming fragmentation in healthcare is an industrywide commitment to defining and measuring value in terms of access, quality, safety, affordability, and the customer experience. That common starting point makes it easier to see how different stakeholders in the system can better work together to deliver such value.
Third, we must address the cost crisis. Rising healthcare costs are a national problem that constrains employers from hiring; drives up out-of-pocket costs and taxes for individuals; exacerbates disparities in access to quality care; and presents a risk of destabilizing our economy. Any effort to improve the healthcare system must prioritize cost control.
Last, we have to develop better ways to connect different stakeholders within the healthcare system in order to align goals, coordinate efforts, and share data and insights. Highmark Health makes those connections internally through our integrated delivery and financing system in western Pennsylvania, and through affiliated businesses in health information technology, and dental and vision products and services. The same mindset drives our collaborations with external provider network partners, such as Geisinger Health Systems in central Pennsylvania, and industry innovators like Quartet Health and Axial Healthcare.