FAQ

What is the VITAL program?

VITAL lever­ages claims-​level and clin­ical data to produce evidence for commer­cially avail­able prod­ucts (devices, tests, and processes) that have not been widely adopted. The VITAL team designs targeted, accel­er­ated, real-​word tests to gathers inte­grated clin­ical, medical cost, and patient expe­ri­ence data. Collaborators then eval­uate the prod­ucts’ clin­ical and cost-​effectiveness and make recom­men­da­tions for market adop­tion.

Why was the VITAL program created?

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.

How is the VITAL program structured?

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.

How long are VITAL tests?

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.

Who is the VITAL team?

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

Who conducts clinical research for VITAL?

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.

What quality controls are in place to ensure the credibility of study results?

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.

What types of solutions are tested?

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.

What are VITAL's clinical focus areas?

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.

What is the size of the member population available for VITAL studies?

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

What has VITAL tested so far and what is currently in the VITAL program's pipeline?

As of January 2018, more than 40 new ideas were under eval­u­a­tion or under devel­op­ment. Additional growth is expected as our program continues to scale. By 2020, the team hopes to manage more than 10 inno­va­tion projects annu­ally.

Can vendors influence the VITAL program's evidence outputs?

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.

Can my local AMC partner participate in VITAL studies?

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.

Could VITAL's evidence outputs be leveraged to support a negative medical policy determination?

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.