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Highmark, Inc., one of the nation’s largest health insurers and among the largest Blue Plans, is a long-time PHC4 data purchaser and supporter of PHC4’s approach to health care data transparency. Highmark serves 5.3 million members in Pennsylvania, West Virginia and Delaware through the company’s health care benefits business. With 20,000 employees across the country, Highmark provides a broad range of health and wellness related services through subsidiary and affiliate companies.

Highmark was created in 1996 and has purchased the PHC4 data almost every year since then. Before that, its predecessors, Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield, also bought the data.

“We were the first payer to buy the statewide inpatient database when it became available for sale back in 1989,” said Joseph J. Reilly, Highmark’s Director of Shared Service Analytics.

Mr. Reilly said PHC4 data complements and supplements Highmark data. He compares Highmark claims data to PHC4 inpatient discharge data to conduct an all-payer market share analysis.

“The unique thing about PHC4 data is that it provides the perspective of all payers, so we can place Highmark in context of what is happening overall in Pennsylvania market areas,” said Mr. Reilly.

The market analysis allows Highmark to understand the primary service area of facilities and to compare the primary service area for Highmark members to the service area of all payers. The data shows Highmark where individuals go for care, outmigration patterns, and allows for trending of inpatient health care use patterns. Highmark also uses PHC4 data for ad-hoc studies on utilization patterns for specific clinical diagnostic categories.

In addition to the PHC4 data it purchases, Highmark makes use of free data available on PHC4’s website. Using the PHC4 County Profile data, Highmark compiles market share reports that include hospital mix and payer mix by county to share with selected hospitals. In preparing these reports, Highmark also uses expense and revenue information from PHC4’s Financial Analysis reports. Highmark also finds PHC4’s Hospital Performance Reports and readmission reports data useful as points of comparison.

The collaborative relationship between Highmark and PHC4 continues today. For example, Highmark’s Don Dabkowski, Vice President of Enterprise Informatics, is a valued member of PHC4’s Payment Data Advisory Group (PDAG), a task force that advises the Council regarding the collection, analysis and reporting of commercial payment data.

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