Highmark launches new company to improve post-hospital care

Aug. 11--Highmark Health announced the creation of a new, for-profit company intended to improve post-hospital care both in nursing home and home care settings. The key: Using data to rank providers, giving larger payments to the best and dropping the worst from the Highmark network.

"We believe we will drive an unprecedented shift in the market to higher levels of service," Dr. Brian Holzer, president of the new company, said during a media phone conference Wednesday morning. The move could be "transformative across Pennsylvania."

The company, dubbed HM Home and Community Services is a limited liability, for-profit corporation. HM HCS will contract with other companies to manage post acute services. Its first customer is Highmark Inc., but Holzer said it is intended to be a "provider-agnostic company dedicated to post acute care."

Holzer said the company works toward three goals:

--"Becoming incredibly precise" in seeing a patient gets the care needed after leaving a hospital, whether that is entering the right skilled nursing home, getting proper home health care support, or simply getting the right home health care equipment.

--Making sure the right amount of each type of care is given. For example, a person shouldn't stay in a skilled nursing home longer than necessary, but should go home better than when they were admitted.

--Making sure the quality of care is as good as possible. This will primarily be done through use of "extensive data" to rank care providers into five tiers based on things like hospital readmission rates and length of stay for a specific condition.

Those ranked the highest quality could receive higher reimbursements for their services, while those ranked at the lowest could be dropped from an insurance network.

Holzer stressed the goal is to help all providers improve, increasing the choices for patients, not to narrow patient options.

And while the plan begins with a relatively limited number of providers in the Highmark network, Holzer said the goal is to refine the data and the resultant rankings and make them "as public as possible" so all providers can work to improve their own rankings and patients can make more informed decisions on their post hospital care.

Reach Mark Guydish at 570-991-6112 or on Twitter @TLMarkGuydish.

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