3 min read February 2023 — In an interview with Invest:, Bruce Meyer, executive vice president and Western PA market president at Highmark Health & Allegheny Health Network, shared insights on the organization’s milestones, the growing trend towards outpatient services, the increasing demand for behavioral health services and the growth in consumer-based access. Meyer also highlighted the need to improve health literacy to prevent avoidable healthcare expenses.
How has demand for your services shifted and what does this say about the current market?
There are four areas to talk about. Firstly, the pandemic accelerated the move of many services that used to be taken care of on the inpatient side into the outpatient arena, creating a bigger demand for outpatient services. Secondly, there is a much larger demand for consumer-based access, such as virtual care and phone access. Lastly, people who postponed a lot of care during the pandemic are now coming back sicker. Our case mix index, which is the way we look at the severity of illness, has continued to climb. This is because they have delayed care for various reasons during the pandemic. The pandemic has affected everyone in this country, not just in healthcare, but also across all spectrums of business and life.
A fourth area that we are seeing in a more prominent way is the need for behavioral health. The pandemic was incredibly isolating for folks, and even coming out of the pandemic, we’re not done caring for COVID patients. We are still learning to live with it and manage our lives. This has had profound effects on people, and behavioral health has become a much greater issue for folks and has received much greater attention. We are still under-resourced, and we are still learning the best ways to provide behavioral health. One of the big shifts is that the bulk of our behavioral health services are now provided in virtual environments rather than in physical environments. This was not the case in 2019.
What strategies are you implementing to address affordability?
Healthcare is incredibly expensive in this country, and there are many things that we are working on to address this issue. One key aspect is improving health literacy, not just in terms of staying healthy and managing illnesses but also financial health literacy. It’s crucial that patients understand their copays, deductibles, and payment options, so they don’t have to choose between basic necessities like heating their homes and filling a prescription. We’re committed to working with patients to make healthcare more accessible and affordable.
Another critical aspect of our efforts is to make healthcare plans more affordable. We offer a range of plans, including those available under the Affordable Care Act (ACA) that allow patients to choose the plan that best suits their financial situation. Patients can select high-deductible plans or lower-cost options that come with a narrower network of providers. Our goal is to tailor healthcare plans to the specific needs of our patients, improving their understanding of the affordability of their options and establishing financial health literacy.
On the provider side, as I mentioned, we are also moving care out of the hospital setting and into outpatient facilities. There is a real cost benefit to that, for payers and patients. For example, we recently started doing hip replacement surgeries in one of our standalone outpatient surgical centers. Years ago, a hip replacement would have been done in the hospital and required a multi-night stay. Now we can do it in a surgery center, get the patient home that same day, and it’s a 25-30% lower cost generally for whoever is paying the bill.
Finally, one of the main drivers of rising healthcare costs is the cost of drugs. Highmark and AHN are working together on strategies to mitigate those costs. For example, both organizations have invested in a nonprofit collaborative, CivicaRx, that manufactures its own generic medications, giving its member organizations price and supply stability. Highmark also recently partnered with a Pittsburgh startup, Free Market Health, that allows specialty pharmacies to bid on patients, getting the best prices for these incredibly expensive specialty drugs. While specialty drugs are used by just a fraction of our members and patients, they account for nearly half of the $5 billion that Highmark spends annually on prescription drugs.
So those are just a couple of examples of how we are trying to bend the cost curve through innovative, patient and member-centric solutions.
How is Highmark Health and the Allegheny Health Network strategizing to recruit and retain talent?
From a healthcare standpoint, we often talk about the nursing shortage, and that is very real. However, we have staff shortages all across the board, including adjacent critical healthcare providers, such as food services, environmental services and community healthcare workers. We need to wrap a system around these shortages. It’s not just about training and hiring more and more of those people; that pipeline has some temporality to it, which will take time to fill the bucket. We need to wrap teams of care around people. For instance, using the nurse as an example, nurses’ aides, licensed practical nurses, community healthcare workers and social workers who are behaviorally health trained need to be part of the care team wherever a nurse is providing care. That way, we don’t rely on the nurse to provide all those services.
The second thing is how we provide a work environment where people feel like they have a rewarding career opportunity and where they can see advancement and a future for themselves. If we don’t provide people with that, then it’s very easy for them to say, “If I can earn $0.50 more an hour, I’m just going to move to another job.” This really relates to the third factor, which is culture. Work culture is crucial; people don’t come to work for a giant organization that has 40,000 employees; they come to work for the manager in their department, and they stay to work for that manager because that manager creates a great work environment. So, it’s about training managers, creating team environments, and developing a culture across an organization that allows you to retain and recruit high-quality people as you grow your business, whether it’s healthcare or any other kind of business. It helps your business succeed, and for us, it’s about trying to help people live their best lives.
What is your outlook for Highmark Health and the Allegheny Health Network and your top priorities for the near future?
I’m incredibly excited about Highmark and what we’re doing in the community. One of the big reasons I came here is because of the Living Health vision and model that Highmark Health CEO David Holmberg and COO Karen Hanlon have established. The model emphasizes the need for a seamless partnership between healthcare providers and healthcare payers, so that we can work together to take care of people in the best way possible. This involves combining resources, using data to make informed decisions and stewarding healthcare dollars more effectively.
We have an unsustainable trajectory in terms of the cost of healthcare in this country, and it’s incumbent upon payers and providers to work together to solve this problem. Our organization’s vision for the Living Health model inspires me, and I’m bullish about the future with Highmark Health. Our priority over the next few years is to create a blended, frictionless payer and provider model, not just between Allegheny Health Network with Highmark, but also between Highmark and the other providers that we collaborate and partner with within Western Pennsylvania, across the state, and in parts of New York, Delaware and West Virginia. Our goal is to set the standard and be a national pacesetter for integrating care and coverage in a manner that truly transforms healthcare.
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