Highmark – UPMC Agree: Health Care Consumers Win
 I am pleased to report that an agreement was reached between Highmark and UPMC to provide in-network access to all UPMC hospitals and doctors through December 31, 2014. My colleague and I, Sen. Don White, conducted a number of meetings with officials from Highmark and UPMC over the last several months in the attempt to bring the parties together and resolve differences.
The Highmark – UPMC agreement is good news for health care consumers. It provides breathing room so that a strong competitive health care market can develop in Western Pennsylvania. The end result will be better, lower cost health care for families throughout the Pittsburgh area.
The agreement extends the existing relationship between the two health care entities and applies to all Highmark subscribers including Highmark Commercial and Medicare Advantage members. The agreement was widely reported:
This is good news for health care consumers. » Read my statement
“For too long there have been too many questions and too much apprehension about where consumers would be able to turn for life-saving health care if this issue were not resolved. Individuals, businesses, workers, seniors and so many others who are impacted can now be assured of access to high quality, low-cost health care for the near future.
“By agreeing to provide access to health care facilities until 2015, the insurance and health care markets in Pittsburgh will have increased stability in a time of market adjustment. This access period will allow time to negotiate an even longer agreement that benefits all health care consumers in the Pittsburgh area.
“The agreement provides the kind of protection that workers, families, businesses, seniors and communities deserve.”
The agreement extends current access to UPMC facilities for 32 months. For 2015 and beyond, Highmark and UPMC will continue negotiating access to specialized UPMC services including those impacting vulnerable populations. This includes access to Western Psychiatric, oncological services and serving patients in continuous treatment at UPMC.
The Highmark – UPMC agreement enables the health care market in the Pittsburgh region to gain stability. As important, it provides enough time for a robust market to be created if the affiliation between Highmark and West Penn Allegheny Health System is approved by the state Insurance Department. That is the next important step toward reforming the health care delivery system in the Pittsburgh region.
I strongly support the affiliation of WPAHS and Highmark because I believe a strong West Penn – Allegheny and a strong UPMC provides market balance and options for the health care consumer. In fact, I testified before a state Insurance Department hearing on this affiliation in mid-April. In my testimony I said that:
“A Highmark-bolstered West Penn - Allegheny would ensure that competition would be available for years to come and sufficient market forces would exist, and present in enough strength, to control costs.
The vertical integration of health care is not new and has been approved in many markets and many regions. In the Pittsburgh area alone, UPMC operates health-care facilities and offers health-care insurance. Health-care facilities currently have insurance arms as a part of their business model."
There is no question that the Highmark – UPMC agreement will relieve anxiety and anguish for millions of health care consumers. Had UPMC and Highmark not have come together and agreed, legislative action would have been taken.
Gov. Tom Corbett said,
"With the assistance of the Legislature backing me up,
(I told them) that if they
did not get this done,
we would get it done for them, and I don't think anybody wants to see government get into what is really a business relationship, and I think they took that to heart and were able to resolve this." |
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To that end, Sen. Don White and I authored legislation (SB 1358) that would have mandated that facility access be maintained without interruption. The fact that this legislation was drafted and both Sen. White and I united in our approach was a key factor that helped forge the agreement.
The governor cited this legislative option and indicated it would be used to spur negotiations if the two sides remained at an impasse.
It is important that we not rest now that the access has been guaranteed to 2015. There is significant work still to be done in ensuring that access continues and future problems resolved. The key is that the health care market continues to develop and Highmark and UPMC remain negotiating and discussing access to unique life-savings services and facilities beyond January 1, 2015.
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