Highmark Health Pioneers the Use of Digital Healthcare Solutions

Highmark Health, a Pittsburgh-based blended healthcare company that employs more than 40,000 people, has been an early adopter when it comes to providing the 6.9 million members of Highmark Health plans in Pennsylvania, Delaware, New York, West Virginia, and across the country with digital health solutions.

Those value-added services include apps, websites and mobile sites that Highmark Health owns or partners with others to provide, as well as text messages, email campaigns, live chat, chatbots and interactive voice response (IVR).

Digital health solutions are important because they create experiences that help to promote “whole person health.” As Tracy Saula, Highmark Health’s Senior Vice President and Chief Product and Experience Officer puts it, “We want to maximize our ability to improve health outcomes at the population level while also delivering an experience that feels like it was designed for a single person.” 

Saula believes that “the key to remarkable health experiences is through simplicity. Therefore, we seek to deliver a seamless, integrated digital experience that connects people to everything they need to manage their health. Healthcare is fragmented, but we don’t have to be.” 

The result of this mindset is that Highmark Health’s digital health future is based on integration and simplification that makes it easy for people to understand and use their benefits, anticipate and manage their health-related finances, and get value through engaging and relevant health and wellness programming.

Quality vs. Quantity  

While many health insurers offer a smorgasbord of digital health solutions, those organizations do not place the same emphasis on quality that Highmark does. “It’s not just about having a digital tool to manage your chronic health condition,” says Saula, “It’s about having the right infrastructure and technical backbone to enable seamless, simple and personalized access to care, coverage and information.” 

She is quick to point out that many plans offer great tools to manage a specific health condition, but that’s all they do. At Highmark Health, the thinking is that people aren’t one illness or disease and that the organization can’t successfully help them manage their health and reach their goals if it continues to fragment how they engage with the healthcare system instead of making the experience smoother and more efficient.

Although the organization has been using digital tools for a long time, the most significant advancements have come over the past 24-36 months as part of its Living Health model, which was launched in December 2020.

A Suite of Solutions, with More on the Way

Among the many digital health solutions that Highmark Health has developed, My Highmark has been the digital front door for Highmark members since January 1, 2024. Co-developed with League, a platform technology company founded a decade ago, My Highmark is designed to help members easily understand which services are covered, which doctors are in-network, and how to get their ID cards. 

“My Highmark delivers value to our stakeholders through a better member experience, reduced administrative costs, and better products and services,” says Saula. “The platform’s effectiveness is illustrated by the 700,000+ members who have adopted the platform in a short time.”

Through My Highmark, numerous members have learned about Mental Well Being, a solution that focuses on providing timely high quality clinical care to support a broad spectrum of behavioral health needs through digital and in-person care options. Mental Well Being can provide self-guided preventive-oriented wellness content, coaching, navigation and therapy services for individuals with moderate diagnoses of depression and anxiety, as well as therapy and medication management for complex and higher acuity behavioral health illnesses.

Launched at the start of this year with strategic partner Spring Health, a mental health solutions provider for health plans and employers, Mental Well Being allows individuals to take a brief yet comprehensive digital assessment of their behavioral health symptoms and goals. The assessment allows them to be matched to personalized care recommendations and clinicians that can best address their needs. With this solution, the average availability of therapy and medication management services is less than three days compared to the national average of 25 days.

Patients are surveyed after all appointments to assess satisfaction with their care team. Survey results and other key metrics are regularly shared with the care team to help them improve the service or care they provide to Highmark health plan members. 

Based on engagement results from January through April of this year, 67% of members in clinical care experienced improved depression symptoms, 59% of members in clinical care experienced improved anxiety symptoms, and the average provider satisfaction score improved to 9.0/10.

According to Saula, “Our Mental Well Being solution’s evidence-based approach can help members achieve remission within six weeks. When behavioral health conditions are treated, patients are better equipped to manage their overall physical health as well.”

When it comes to healthy bodies, Virtual Physical Care was developed by Highmark Health in collaboration with Sword Health, a digital musculoskeletal (MSK) care provider with a mission of freeing people from chronic, acute and post-surgical pain. Sword Health’s clinical-grade digital MSK care platform pairs expert physical therapists with wearable technology and computer vision technology to deliver a personalized treatment plan that is more convenient, effective and easier to use than traditional treatment plans. The plans are related to all major joints and all phases of the pain spectrum, including acute, chronic, pre-op and post-surgery. 

The Virtual Physical Care Program consists of Licensed Physical Therapists assessing and recommending pain management care plans through virtual technology, and motion sensing technology to provide real-time feedback on exercise effectiveness that is more accurate than human eyes.

To date, Highmark has seen a 36% decrease in member requests for surgery and a 31% decrease in maximum pain
intensity.

Also available through My Highmark, the Well360 Virtual Health suite, offered through a strategic partnership with AmWell, provides convenient, accessible Urgent Care, Primary Care, Women's Health and Dermatology services that reduce wait times, improve patient satisfaction, and decrease the cost of care when compared to in-person care modalities.

An Easier Way to Access Billing & Payment Information

On the business side of healthcare, for the past couple of years, Cedar Pay has been addressing systemic challenges consumers face when paying for healthcare. Says Saula, “The Cedar Pay solution powers the patient billing experience at Allegheny Health Network (AHN) to improve the end-to-end consumer financial journey.”

Saula believes that “the key to remarkable health experiences is through simplicity. Therefore, we seek to deliver a seamless, integrated digital experience that connects people to everything they need to manage their health. Healthcare is fragmented, but we don’t have to be.” 

Highmark Health has collaborated with Cedar on the Payer Intelligence Layer (PIL) of the solution, which integrates data from health insurers with providers’ databases to provide a single information source for medical bill payments. This feature allows consumers to access explanations of benefits, real-time deductible status, and health benefit account balances in the same place where they view and resolve medical bills by using a single, intuitive interface. 

Unlike other systems, Cedar ensures consumers have the most current information at their fingertips by integrating Cedar Pay PIL with the patient experience.  As a result, to date, Highmark and AHN have seen a dramatic increase in self-service digital engagement, increased utilization of HSA and FSA funds, and higher patient satisfaction. “That reality is truly a win-win,” says Saula.

Innovating the Clinical Experience

In the hospital setting, Virtual Nursing at AHN leverages the most advanced in-room sensors using artificial intelligence (AI) and automated documentation capture to power virtual admissions, physician rounds and discharge workflows. Developed internally, the technology is supported by Care.AI, a company that builds AI platforms and uses advanced sensor technology to improve healthcare delivery.

Virtual Nursing improves the patient experience in two fundamental ways: It allows the bedside nurse to eliminate many of their administrative tasks and focus instead on caring for patients. It also enables nurses to bring caretakers such as family members into the discharge process, improving outcomes due to nurses’ improved understanding of patients’ social situations and health literacy. 

Since AHN began using the platform early last year, bedside nursing staff has increased its efficiency by 30% and there has been a 30% increase in discharges before 11:00 a.m. Additionally, overtime costs have dropped approximately 50%.

“The Virtual Nursing capabilities use the latest technologies to provide more efficient, more effective care while also promoting clinician wellness and joy in practice,” according to Ashis Barad, MD, AHN’s Chief Digital and Information Officer. “As the Digital Nursing program grows,
responsibilities could also expand to include charting and active patient monitoring."  

“We want our nurses to practice at the top of their licenses,” Barad said. “Our Virtual Nursing team allows our bedside nurses to do just that. In the process, we are transforming the nursing profession, establishing AHN as a destination for nursing professionals, and setting new workplace and flexibility standards for our industry.”

As consumers increasingly prefer to access services and information online and want a frictionless retail-type experience when accessing healthcare services and information, Highmark Health’s investments in digital healthcare solutions position the organization to create and maintain strong relationships between members and providers.