Value-Based Reimbursement Programs

Quality Blue Hospital Program

Highmark's mission is to provide access to affordable, quality healthcare and enable individuals to live longer, healthier lives. Participants in the Quality Blue Hospital Pay for Value Program partner with Highmark to advance this mission at the point of patient care, throughout the facility and in the community at large.

The Highmark Quality Blue Hospital Pay for Value Program affords Highmark an opportunity to partner with network hospitals toward the common goal of improving patient care and safety. The program aligns with nationally recognized guidelines and incorporates industry standards and evidence-based care. The Quality Blue Hospital program focuses on key public health issues and quality indicators that have been identified nationally as areas for improvement.

Additional information regarding the Quality Blue Hospital Program can be obtained by reviewing Chapter 5 of the Highmark Provider Manual.

Specialist Performance Initiative

Highmark continues to expand its portfolio of value-based care programs and initiatives to include addressing specialist cost transparency and performance with the Specialist Performance Initiative (SPI). Starting December 2020, Highmark will offer select specialists a cost profile tool that provides physician-level data to inform practice performance, influence clinician behavior and optimize referral patterns.

SPI will include ranking information on over 11,000 specialists in 14 clinical specialty groupings and 52 clinical condition categories giving Highmark’s network brand new insights into performance to help them provide and guide our members to the highest value care possible. SPI includes the following specialties: cardiologists, dermatologists, endocrinologists, gastroenterologists, general surgeons, gynecologists, nephrologists, neurologists, ophthalmologists, orthopedic specialists, psychologists, pulmonologists, rheumatologists, and urologists. This initiative applies to all Highmark service areas in Pennsylvania, Delaware and West Virginia.

If you have questions regarding SPI, submit your inquiry to SpecialistPerformance@highmark.com.

True Performance Program

This is a contracted program that replaced all previous pay-for-value and quality incentive PCP programs across all markets and member populations. This program is designed to continue to improve the quality of healthcare delivered to our members while working to reduce the overall cost of healthcare for our members. For our provider partners, True Performance reduces the complexity of multiple programs, offers a higher performance based reimbursement opportunity, and provides timely and actionable reporting. PCP entities with 250 or more members will be eligible to participate in the new program.

Log in to NaviNet, then navigate to the Resource Center for all the information, including training and education, on these and other programs.