Highmark is committed to partnering with health care providers to guarantee that our members receive high-quality, cost-effective care in the most appropriate setting. To align with this commitment, we want to ensure that our patients are able to access providers that plan and manage care in an efficient, cost-effective manner with high quality standards.
Using a specific set of performance metrics, Highmark measured the components of the care provided by current participating physical therapists, occupational therapists, speech therapists and doctors of chiropractic medicine across the network. As a result of that review, Highmark determined that while all participating physical therapists and doctors of chiropractic medicine provide quality care, some providers had a lower adherence to clinical protocols, higher than average cost, and a higher number of visits than average — all of which can lead to higher costs for members and a less than optimal patient experience.
As a result, only those participating physical therapists and doctors of chiropractic medicine who met or exceeded Highmark’s performance benchmarks will be included in the High Performing Physical, Occupational, and Speech Therapy Network or the High Performing Chiropractic Network. These providers will also be placed at the highest benefit tier for commercial tiered products using the new Networks. These providers will also be considered In Network for Medicare Advantage Community Blue Plans and ACA Direct Blue plans.
Highmark is committed to keeping these networks up to date by using the most recent metric data available; therefore, Physical Therapists, Occupational Therapists, Speech Therapists and Chiropractors will be evaluated on an annual basis.
Last updated on 11/15/2021