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Highmark Health designed the VITAL program to provide creative care delivery solu­tions for physi­cians in a highly compet­i­tive western Pennsylvania market. Since its launch in 2015, the VITAL program has been fostering collab­o­ra­tion to advance inno­va­tion:

• Clinicians are rewarded for proposing ideas and funding to solve key issues.
• Eligible members of a Pennsylvania health plan gain earlier access to promising new treat­ment options with proven outcomes.
• The Pennsylvania health plan gains medical policy effi­cien­cies and cost savings as new care solu­tions are adopted.

Highmark Health devel­oped VITAL to leverage the unique capa­bil­i­ties, data, and exper­tise of Allegheny Health Network clin­i­cians and a large Pennsylvania health plan.

Highmark Health Role

Highmark Health funds the VITAL program and provides the analytics to support VITAL’s research studies. It also iden­ti­fies eligible members for studies. Under the Highmark Health umbrella, the VITAL team aggre­gates, analyzes, and pack­ages test results for its collab­o­ra­tors.

Allegheny Health Network Role

Allegheny Health Network (AHN) clin­i­cians develop proposals for candi­date solu­tions based on iden­ti­fied needs. Because all VITAL projects require a physi­cian sponsor, AHN clin­i­cians also partic­i­pate in testing and gath­ering data in areas that match with their exper­tise.

Large Pennsylvania Health Plan Role

The partic­i­pating Pennsylvania health plan is a ​“customer” of the VITAL program. It over­sees VITAL’s solu­tion selec­tion process and the prior­i­ti­za­tion of projects. It also manages the claims data required to measure cost-​efficiency. And it helps inform VITAL’s health-​plan-​focused evidence outputs.

The typical eval­u­a­tion processes takes 6 – 18 months, depending on the quality of evidence avail­able for review prior to test launch. The VITAL team eval­u­ates new solu­tions and conducts tests in parallel as capacity allows.

The VITAL team is made up of data scien­tists, clin­ical researchers, and busi­ness devel­op­ment leads who are experts in analytics and program manage­ment.

VITAL is connected with more than 2,800 Allegheny Health Network (AHN) clin­i­cians across 8 hospi­tals, plus inde­pen­dent physi­cians in western Pennsylvania. We either invite certain experts to partic­i­pate in our tests or they volun­teer. Oftentimes, experts from the AHN Research Institute partic­i­pate in our research programs. They specialize in more than 120 areas of medi­cine.

Before we launch at test, the VITAL team thor­oughly vets candi­dates for the program through a Landscape Assessment and Solution Impact Assessment processes. We select only those solu­tions most likely to produce posi­tive results. We monitor key perfor­mance indi­ca­tors to ensure projects are scaled, adjusted, or curtailed as appro­priate.

The VITAL team eval­u­ates health care tech­nolo­gies, labs, and/​or processes that are commer­cially avail­able and have received FDA approval — or other certi­fi­ca­tion equiv­a­lents (e.g., CLIA certi­fi­ca­tion for labs) — but have not yet received coverage under most health plan medical poli­cies. We prior­i­tize candi­dates based on how a company’s needs match with our capa­bil­i­ties. We currently do not test phar­ma­ceu­tical ther­a­pies.

Our clin­ical focus areas currently include oncology, women’s services, cardiac care, diabetes, chronic obstruc­tive pulmonary disease (COPD), preci­sion medi­cine, and digital ther­a­peu­tics. We may consider other areas on a case-​by-​case basis.

VITAL tests cur­rently draw on data from more than 5 million health plan members.

VITAL is committed to preserving objec­tive and trans­parent processes. As such, the VITAL team will dissem­i­nate all rele­vant test results to health plan constituents regard­less of whether they are posi­tive, nega­tive, or incon­clu­sive. Vendors will not be allowed to prevent or influ­ence test outcome distri­b­u­tion.

At this time, only certain providers may execute VITAL tests. We are currently exploring oppor­tu­ni­ties to coor­di­nate and scale tests across health plan geogra­phies, however.

VITAL’s main goal is to support the improve­ment of health care delivery. We decide to test solu­tions that are likely to deliver posi­tive health and patient expe­ri­ence outcomes at compet­i­tive costs. 

VITAL is also committed to its role as an objec­tive, trans­parent, source for evidence. Therefore, we will dissem­i­nate posi­tive, nega­tive, and incon­clu­sive outcomes for all eval­u­ated solu­tions. Health plans retain full discre­tion over whether and how to apply find­ings inter­nally. In some cases, test results may be used to support a plan’s ratio­nale for excluding a solu­tion from coverage.