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Radar On Market Access: Highmark Expands Proving Ground for Innovative Therapies

Posted by Leslie Small on Feb 28, 2019

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After Highmark Health expanded from an insurer to an integrated delivery system, the organization decided it was uniquely positioned to launch a platform to test early-stage, FDA-approved medical innovations that were struggling to attain the evidence needed for widespread adoption — and, critically, insurance reimbursement, AIS Health reported.

Nearly four years later, Highmark Health Plan and its affiliate Allegheny Health Network have changed their policies and purchasing contracts to provide therapeutic innovations to members after gathering evidence on their effectiveness. Examples include HeartFlow, which can create a 3D model of coronary arteries and blockages, and FreeSpira, a digital therapeutic that reduces debilitating panic attacks.
 
Highmark also opted to transform VITAL from an internal platform to a commercial offering — meaning companies pay Highmark to test their products, says Eileen Rodgers, director of Highmark's VITAL Innovation Program.

Making VITAL a commercial offering, according to Rodgers, helps it source new innovations and make the program a recognizable name out in the marketplace. "Our intent really is to draw new innovations to Highmark Health as kind of a center of gravity," she says.

For the startup companies that work with VITAL, the services the program offers can be the difference between staying afloat or going under, Rodgers points out.

"A lot of innovations are FDA approved and make it past clinical trials to be commercially available, but because there's no financing mechanism, the delivery systems are unable to buy them," she says.

But the real-world evidence VITAL provides can help startups get over that hurdle faster by making payers' decision to cover their product a safer bet.


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Topics: Data & Analytics, Provider, Payer