Highmark Program Boosts Patient-Center Care With $5.5 Million In PCP Compensation
By Christine Kern, contributing writer
Program aims to ensure correct diagnosis codes for complex chronic conditions.
In an effort to improve continuity, quality, and timely coordination of care for its members with chronic conditions, Highmark has announced the availability ofup to $5.5 million in compensation for primary care physicians to address unconfirmed diagnosis codes. The move underscores Highmark’s commitment to patient-centered care.
“Primary care physicians are critical partners with us in managing our members' care, especially those with complex chronic conditions,” Highmark Vice President and Medical Director Amy Fahrenkopf, M.D., asserted in the statement.“This effort compensates doctors who are working with our members in government-focused programs, ties our reimbursement to high-quality care and allows us to better serve some of our most vulnerable patients with care management and coaching.”
The goal of the program is to help ensure the accurate identification, assessment, documentation, and reporting of diagnosis codes. This is particularly important in light of the additional codes created under ICD-10. Future updates are also anticipated to add some 5,500 codes next year.
The new Highmark program applies to some 2,800 Pennsylvania primary care physicians who see some 200,000 members with Highmark Medicare Advantage or Affordable Care Act (ACA) health plans.
“Each of these government-focused programs pay health plans for the health risk associated with their members,” added Fahrenkopf. “As our focus on unconfirmed diagnosis codes becomes more widely accepted with physician reporting, there is also a direct correlation to the moderation of insurance premiums for these members' plans.”
While Highmark has compensated primary care physicians for confirming and documenting patient diagnoses in the past, this latest move will make more funding available for physicians who accurately complete documentation on a higher percentage of their patient base.