Right Care Program

*Highmark will notify providers when access to the Right Care program metrics are available.

Right Care is a Highmark clinician-led program to reduce clinical variability and improve appropriateness of care. It's done to make sure our members receive the right care, at the right place, and the right time. ​​​​​​​No more, no less.​​​​​​​​​​​​​​ Right Care is the clinical approach in helping drive the quadruple aim to improve outcomes, clinician experience, patient experience, and affordability.

Our mission is to:

• Ensure all Highmark members receive the right care, at the right place, at the right time.​​​​​​​​​​​​​​
  
• Reduce overuse of services that expose members to unnecessary risk or cost where there is no net clinical benefit.​​​​​​​
• Promote increased use of proactive, preventative, and conservative therapies that result in better outcomes.

Right Care's primary intervention is collaborating with providers to drive performance management and behavior change within networks. This could include peer-to-peer coaching, all the way to the development of new care models. Additionally, Right Care engages other departments to drive action in ways such as revising medical policy, inclusion in Value Based Reimbursement (VBR) programs, and other initiatives for improvement.

See Some of Our Success Stories

In the videos linked below, Sricharan Chalikonda, MD, MHA, FACS, medical director of Right Care, presents an overview of the program, and shares his perspective on why appropriateness measures are so critical in evaluating quality of care.

Segment #1 - Introduction to Right Care

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Segment #2 - How is Right Care different?

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Segment #3 - The clinician partnership (Penn State Health)

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Segment #4 - How are measures developed?

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Segment #5 - An example metric

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Segment #6 - How else are measures used?

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Segment #7 - How has this been implemented?

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* By accessing the videos above, I understand that I am leaving the Highmark PRC website and will be redirected to an external website operated by a third-party platform provider. Any use of the third-party platform provider’s website and any information you provide will be subject to and governed by the terms of the third party, including those relating to confidentiality, data privacy, and security.

The results for the initial set of metrics will be available on the Provider Facing Analytics platform accessible from our online provider portal. Each metric will include the definition and parameters, as well as a distribution of individual physicians’ performance. Providers can see where they specifically fall within the distribution and their performance relative to their peers.

Once available, you'll be able to access your report by contacting your online provider portal Security Officer.

If you have ideas for Right Care initiatives or have questions about the program, please send them to RightCare@highmark.com.