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Unique Program Means Better Care for Highmark Members

NCQA program targets those with chronic conditions

PITTSBURGH, Dec. 3 /PRNewswire/ -- As part of its ongoing effort to ensure quality care for its members, Highmark Inc. is encouraging physicians to pursue National Committee on Quality Assurance (NCQA) certification during a pilot program. Highmark's support of the physician recognition program certification is unique as Highmark is one of the few health insurers in the country offering a program of this kind to motivate physicians to earn the certification.

In a survey of participating physicians conducted by Highmark, 69 percent agreed that their patients had improved outcomes as a result of the program. Also, 95 percent said it was a worthwhile activity for their practice.

The program began in January with 538 physicians participating. Physicians could work toward one of three NCQA certifications. The three programs include:
-- Physician Practice Connections, which recognizes physician practices

that use enhanced management of information to improve the quality of

patient care;

-- Diabetes Physician Recognition Program, which recognizes physicians who

demonstrate they provide high-quality care to patients with diabetes;

-- Heart/Stroke Recognition Program, a program where physicians

demonstrate they provide high-quality care to patients with cardiac

conditions or who have had a stroke.

"These designations are important because they require physicians to demonstrate that they are following national quality guidelines for treating patients with chronic conditions such as diabetes and heart disease," said Michael Madden, M.D., medical director of medical performance management at Highmark. "We know that a disproportionate amount of health care spending is for patients with chronic conditions, so we are hoping over time this program will prove to be beneficial for patients as well as the physicians who are earning this recognition."

The program has several levels for the physician to work through. In the first phase, Highmark offered the physicians a pre-survey allowing them to examine their practice patterns and how they manage the care of patients with chronic conditions.

After the survey was completed, Highmark's medical management consultants reviewed the results with the physicians to develop strategies to correct any gaps that were identified to help ensure the providers satisfy the NCQA standards.

In the second phase, a physician completed the NCQA application and workbook or survey tool based on the practice patterns for all the physicians' patients. In the final level, the physician received financial reimbursement from Highmark when the certification was awarded to the provider.

"This initiative provides an excellent framework for physicians, staff, and patients to work together to improve the health of patients with diabetes. We feel strongly that this ongoing collaborative effort has improved the care of our patients," said Gregory Walker, M.D., Internal Medicine Specialists, Aliquippa.

The 433 network physicians that have completed the program have the potential of improving care for about 55,000 Highmark members with chronic conditions from the practices that participated.

Highmark launched the certification pilot program in January 2007 and during the next two years Highmark will evaluate the program's effectiveness in improving care and reducing costs.

About Highmark Inc.

As one of the leading health insurers in Pennsylvania, Highmark Inc.'s mission is to provide access to affordable, quality health care enabling individuals to live longer, healthier lives. Based in Pittsburgh, Highmark serves 4.6 million people through the company's health care benefits business.

Highmark contributes millions of dollars to help keep quality health care programs affordable and to support community-based programs that work to improve people's health. Highmark exerts an enormous economic impact throughout Pennsylvania. A recent study states that Highmark's positive impact exceeded $2.5 billion. The company provides the resources to give its members a greater hand in their health.

SOURCE Highmark Inc.
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