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Why Highmark’s Looking to ScaleUP


Published Apr 7, 2021 • by AHIP

Consumers expect health care to be simpler, more affordable, and accessible. Organizations must make continual investments in technology and administrative services to help members manage and improve their health and enhance their overall experience. Large, for-profit organizations and unconventional, tech-savvy competitors are also entering markets, putting additional pressure on non-profits that have served communities for generations.

In this health care landscape, status quo isn’t an option. We must adapt and grow to succeed. That’s why Highmark is executing a multi-faceted growth strategy—called ScaleUP—that positions us to deliver upon consumers’ expectations now and in the future. Strategic affiliations, provider partnerships and joint ventures, and digital solutions fuel our ScaleUP strategy.

Fueling our Living Health Model

Highmark is committed to creating a Living Health model, which builds a better system for our customers and clinicians through innovative solutions and partnerships to deliver them. Growth is the engine of Living Health. Growth helps us to maintain our position as a national leader among Blue Cross Blue Shield health plans, strengthens our ability to shape care locally and invest in our Living Health model, and improves our cost competitiveness. That translates to better care, lower cost, and greater access for our members and patients.

Delivering Innovation, Preserving Local Identity

A major proof point for our ScaleUP strategy is our recent affiliation with HealthNow New York, which makes Highmark the primary licensee of the Blue Cross Blue Shield Association for HealthNow’s western and northeastern New York service areas. Highmark and HealthNow have both proudly served generations of members, patients, and broader communities. This affiliation is a major win for approximately 800,000 HealthNow members, local employers, and New York residents. It links two mission-driven organizations that believe in the power of community-based care, and delivers Highmark’s innovative insurance products and technological capabilities to new customers.

Highmark has a proud history of completing affiliations that maintain local identity and decision-making, while also unlocking new resources for local customers, employers, employees, and the community at large. Over the past two decades, Highmark has affiliated with statewide Blue Cross Blue Shield plans in West Virginia and Delaware, and we merged with Blue Cross of Northeastern Pennsylvania. Local leaders who know their communities best play key roles in governance and day-to-day operations. We will honor that commitment with HealthNow as well.

Strengthening Community-Based Care

Provider partnerships are another crucial component of our ScaleUP strategy. Highmark has developed a continuum of provider partnerships, clinical joint ventures, and integrations that create community-based networks of primary and specialty care.

In western Pennsylvania, we made a more than $1 billion investment in Allegheny Health Network (AHN) to create access points, preserve choice, and connect health insurance and care in new ways. Through the Highmark-AHN partnership, we test new value-based models for both health care delivery and reimbursement, refine them, and roll them out more broadly in the marketplace with other anchor partners.

In central Pennsylvania, we’re partnering with Penn State Health for a more than $1 billion joint investment to create new health care access points, including through new local hospitals and clinics in the communities we serve. We have created a Clinically Integrated Network of more than 100 community physicians to improve chronic disease prevention and management. We have also partnered with employers to develop health insurance solutions with lower costs through Penn State Health, and Highmark has invested $25 million in the Penn State Health Cancer Institute. We’re also collaborating with WellSpan Health in central Pennsylvania to improve care, engage clinicians, and lower costs.

In partnership with Lehigh Valley Health Network, we launched a health insurance product that has improved health outcomes and lowered costs. We have also partnered with Geisinger on a clinical joint venture that invests more than $100 million to improve access to care for residents of northcentral Pennsylvania.

Scaling Digital Solutions

Highmark has developed and scaled industry-leading technology solutions. HM Health Solutions (HMHS), a Highmark Health company, delivers business solutions to health plan payers so they can run their organizations more efficiently in an ever-changing market. HMHS has partnered with 12 health plans serving 11 million members, offering a comprehensive platform that manages functions from sales through enrollment and billing, including claims, provider clinical management, and customer service.

Ultimately, ScaleUP is about boosting health care affordability and accessibility, better engaging members and clinicians, and continuing a legacy of community-oriented health care service. ScaleUP builds upon our proud, 80-plus year history, and helps us continue to create remarkable health experiences for more customers and communities for generations to come.