Value-Based Reimbursement

Medicare Advantage Stars

The CMS one- to five-Star Rating scale measures the overall quality of Medicare Advantage and drug plans. The program ties care quality to financial reimbursements. It rewards high-performing plans, while pressuring low-performing plans to improve or exit the market.

Quality Blue Hospital Program

Network hospitals in this program collaborate with Highmark to enhance patient care and safety. Together, we work to provide access to affordable, quality healthcare and enable individuals to live longer, healthier lives.

Specialist Performance Initiative

This initiative in our PA, DE, and WV service areas helps increase specialist cost transparency and performance. A cost profile tool helps PCPs find the highest value specialist care possible for Highmark members. 

True Performance Programs

Highmark’s True Performance Programs aim to improve quality and reduce overall healthcare cost for our members. Our suite of programs covers home health, physical and occupational therapy, skilled nursing facilities, and more.

Best Practice

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Know more about streamlined payments for complex care  beyond traditional in-office visits, ensuring predictable costs based on factors like quality, efficiency and patient needs

Incentive Programs

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Discover how to earn rewards for providing high-quality pediatric care, including behavioural health services, and be recognized for you exceptional work.