The past year was successful for Highmark Health Plan. We added new capabilities throughout our footprint and expanded employer health care plans into southeastern Pennsylvania.
We lead with value and innovation to create employee benefit plans that work for more people in more places. Our team consistently finds new ways to serve diverse urban and rural businesses and communities, with a focus on the whole person.
“As a purpose-driven blended health organization, we build relationships that align with our mission,” says Tom Doran, President of Highmark Health Plans. “We are making health care more affordable and accessible for all.”
Highmark finalized our expansion into the southeastern PA (SEPA) region in 2024. This move brings more innovative and competitive plans to the area, with a community-focused approach to care. Highmark is now the only Blue Cross Blue Shield (BCBS) entity to serve the entire state.
We had 75,000+ members in SEPA by December 2024 — three times our original estimate. About 100 Highmark employees work to serve these members, helping to create a better system for whole-person health.
We are doing this with:
Highmark has a three-pronged strategy to improve prescription drug plans for our members. Our pharmacy initiatives target lower prescription drug costs, faster access to specialty medications, and integrated pharmacy benefits.
We seek out relationships that help create value for our customers and members.
These include:
Highmark works with Pittsburgh-based company Free Market Health to facilitate access to medications from specialty pharmacies. Members get specialty medications quicker and thus are less likely to abandon their care plans.
Members with complex health conditions benefit from pharmacies vetted for quality care management that balances cost and drug efficacy. For example, more than 85% of Highmark members with cystic fibrosis (CF) have access to a specialty pharmacy dedicated to CF care.
Pharmacies can also screen our members for social determinant of health (SDOH) needs and triage them to a case manager. SDOH includes food insecurity, unsafe housing, lack of transportation, and other external factors that impact health and wellness.
Group customers that integrate medical and pharmacy benefits within their Highmark health plan can save thousands of dollars. The average savings is between $150 and $230 per member, per year. In addition to lower drug costs, integrated plan members have shorter hospital stays and improved engagement with care programs.
The COVID-19 pandemic highlighted the demand for behavioral health care. Highmark acted with accessibility as our mandate. Mental Well-Being powered by Spring Health has expanded access by 40% for our members. This is a major improvement for members who live in underserved areas with long wait times and higher costs.
Mental Well-Being offers multiple levels of personalized support, such as:
Members using this program have quickly reached remission in the severity of their anxiety and/or depression symptoms. Early data shows three times faster results than the national average of three to six months.
About 80% of these members are now connected to mental health care resources for the first time in at least 18 months. “We have seen high member satisfaction,” says Doran. “Members are having success with the service and are happy to get a good outcome.”
Employers have the option of adding Mental Well-Being to their Highmark employee benefits package. We will also be offering EAP + Mental Well-Being in 2025 to more comprehensively meet our members’ needs.
Highmark takes great pride in becoming part of the fabric of the communities we serve. Our Bright Blue Futures program highlights charitable giving and community involvement. We take an investment approach to funding different initiatives to build healthy, resilient communities.
As we grow our business, we also grow our ability to support the well-being of all people in our service area. The pillars of Bright Blue Futures include:
“What I like most about Bright Blue Futures is that we have a local presence wherever we do business,” says Doran. “Every initiative aligns with our mission around health care access and engagement, and each one makes an impact. These organizations are doing tremendous work and we’re investing in them.”
We have more innovations, improvements, and investments planned for the year ahead. Contact your broker or client manager to learn how we’re adding quality and value to employee health — every day.
All references to “Highmark” in this communication are references to Highmark Inc., an independent licensee of the Blue Cross Blue Shield Association, and/or to one or more of its affiliated Blue companies.
Spring Health is an independent company that provides mental health care services through its agents. Spring Health does not provide Blue Cross and/or Blue Shield products or services. Spring Health is solely responsible for their mental health care services.
Talk to your client manager today and we’ll help you find the right health plan for your company.
