Value Based Reimbursement Programs

Medicare Advantage Stars

The Centers for Medicare and Medicaid Services (CMS) rates Medicare Advantage plans and prescription drug plans separately on a scale of one to five stars, with five representing the highest quality. The Star Rating for Medicare Advantage plans is an overall measure of the plan's quality, and is a cumulative indicator of: Quality of care, Access to care, Beneficiary satisfaction, Customer Service, and Responsiveness to member needs. The intent of the program is to tie quality of care to financial reimbursements, whereby rewarding high performing plans and forcing low performing plans to exit the market.

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-Performance Program partner with Highmark to advance this mission at the point of patient care, throughout the facility and in the community at large. 

Skilled Nursing Facility Pay-For-Value Program

The Highmark SNF Pay-For-Value Program is designed to reward post-acute care partners for their contributions to quality care and align financial incentives with improved quality outcomes.

Specialist Performance Initiative

 True Performance

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.

Last updated on 12/17/2020


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