Right Care Program

Last Updated: Friday, June 26, 2026

About Right Care

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 at the right time. Right Care is the clinical approach in helping drive the quintuple aim to improve outcomes, clinician experience, patient experience, and affordability.

Our mission is to ensure members receive the right care, at the right place, at the right time by reducing overuse of services that expose patients to unnecessary risk or cost where there is no net clinical benefit; as well as promoting increased use of proactive, preventive, and conservative therapies that result in better outcomes.

Right Care Categories No results were found for the keyword entered.	Appropriateness No results were found for the keyword entered.	Waste No results were found for the keyword entered.	Abuse No results were found for the keyword entered.	Identification of Fraud No results were found for the keyword entered.
Description No results were found for the keyword entered.	Refers to whether the healthcare services provided are the right ones for a patient's specific medical needs, in the right setting, and at the right time. It essentially evaluates if the care is effective, necessary, and aligned with current medical standards and best practices. No results were found for the keyword entered.	Refers to inefficiencies, unnecessary expenses, or suboptimal utilization of resources within the medical management process that do not contribute to improved patient outcomes or care quality. No results were found for the keyword entered.	Refers to practices that deviate from ethical, professional, or policy standards within healthcare, leading to financial or other advantages for individuals / organizations, often harming patients or the system, without necessarily being outright fraud. No results were found for the keyword entered.	Refers to intentional deception or misrepresentation to gain unauthorized benefits (money, services) by misleading, misrepresenting, or concealing information. No results were found for the keyword entered.
Examples No results were found for the keyword entered.	Overutilization of services Underutilization of effective services/brands/biosimilars No results were found for the keyword entered.	Prescription Drug Wastage Unnecessary imaging (MRI for routine back pain w/o red flags) Excessive lab tests Elective surgeries that could be managed conservatively No results were found for the keyword entered.	Upcoding, Unbundling Misrepresenting services Billing for services that are not medically necessary, but without clear intent to defraud No results were found for the keyword entered.	Billing for services not rendered, Upcoding Forging prescriptions or medical records Performing medically unnecessary services Phantom billing No results were found for the keyword entered.
Specific Initiatives No results were found for the keyword entered.	Overuse of advanced cardiac procedures Underutilization of cost-effective alternatives Unnecessary diagnostic imaging No results were found for the keyword entered.	High-cost drug overpayments Duplicative testing Inefficient utilization of medical equipment No results were found for the keyword entered.	Elective procedures performed without sufficient clinical justification Services with marginal patient outcome improvement No results were found for the keyword entered.	Unauthorizd prescriptions for specific conditions Billing for services not rendered No results were found for the keyword entered.

Partner With Us

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