How Highmark Health Made this Transition Towards a Tech-Driven Healthcare Future

Highmark Health, a significant player in the US health insurance sector, has set its sights on transforming the healthcare landscape, leveraging technology to enhance patient experiences and streamline operations. The organisation's journey, over a decade, has been marked by significant growth and a shift towards a digitally focused model.

The first phase of this journey commenced in 2013 when Highmark Health was established through the merger of Highmark Blue Cross Blue Shield and West Penn Allegheny Health System (WPAHS). 

This period was dominated by a legal battle with UPMC, the largest healthcare system in the Pittsburgh region, prompting Highmark to envision a future without UPMC contracts. Despite the challenges, Highmark forged ahead, creating Allegheny Health Network (AHN) and diversifying its services for members.

Looking Back

The turning point came in 2019 with the resolution of the UPMC-Highmark dispute. Looking beyond the pandemic's impact, Highmark Health, with its vast revenue of $26 billion, embarked on an ambitious mission to transform the nation's healthcare system. Key figures within the organisation, including CEO David Holmberg and COO Karen Hanlon, recognised the need for fundamental changes in patient care, provider engagement, and cost containment.

Transformation became the linchpin of Highmark Health's strategy. Over the years, the organisation invested heavily in bolstering its services and forming strategic alliances. On the provider side, it expanded AHN, established cancer care networks, and partnered with renowned healthcare institutions including Johns Hopkins Medicine and Penn State Health. On the insurance front, it acquired additional Blue Cross Blue Shield plans and expanded its footprint into new territories.

Digital-Focused Model Through Living Health  

Today, Highmark Health is evolving into a digitally focused entity, investing millions in building an infrastructure conducive to a comprehensive digital healthcare experience. Central to this transformation is the Living Health model, which provides a seamless digital journey for members, enabling them to navigate healthcare processes effortlessly via smartphones, tablets, or computers. This initiative leverages artificial intelligence and digital connections with healthcare providers to personalise healthcare pathways, particularly in managing chronic conditions and predictive analytics to pre-empt health issues.

Virtual options for urgent care, primary care, behavioral health, and physical therapy have been integrated, demonstrating the organisation's commitment to embracing the digital age. Automation is also being implemented in utilisation management and prior authorisations to enhance the customer experience and streamline processes.

However, this transformation isn't without its challenges. Internal restructuring has made some roles obsolete, necessitating layoffs and redeployments. Highmark Health is carefully managing this transition, balancing embracing technology and retaining a skilled workforce. The organisation's financial performance has shown promise, with increased revenue and membership growth.

Highmark Health's innovative initiatives, like Living Health, have garnered positive attention, emphasising its commitment to transforming the healthcare experience. As the organisation actively engages with other healthcare providers, it aims to create a transformative ripple effect, ultimately delivering improved outcomes, reduced costs, and a simplified healthcare journey.