Lost in concerns over the so-called “ad wars” between UPMC
is the fact that virtually every person in this region, come the end of the UPMC-Highmark
contracts in 2015, will have the choice of full, in-network access to UPMC. That’s
right—despite Highmark’s dubious ad claims—no one will be “denied” access to
The people of western Pennsylvania will have more insurance choices
than ever before to ensure the full, in-network access to UPMC they desire
while their premium costs are being held down. And they’ll be living in one of
the few cities in the country with two competing health systems that integrate
both a provider network and an insurance company, the type of system that
experts say can better coordinate care and lower costs.
So why can’t this promising new health care landscape in Pittsburgh be
embraced and the ad madness we’re enduring be stopped?
Unfortunately, the answer is that Highmark refuses to give up on its
fruitless quest of a UPMC contract. Undermining its own plan to “save” the West
Penn Allegheny Health System (WPAHS)—a plan approved by the Pennsylvania
Insurance Department (PID) and that is predicated entirely on the assumption of
“no commercial contract” with UPMC in the future—Highmark is relentlessly
pursuing by any means possible a new or extended contract with UPMC.
What Highmark wants would be bad for the former WPAHS (now part of the
Allegheny Health Network), bad for this community, and bad for UPMC and the
more than 63,000 employees who have helped to create one of the nation’s top 10
If you don’t believe us, read Highmark’s own filings with the PID. Highmark
has said that expiration of the contracts with UPMC is essential to saving the
near-bankrupt WPAHS and that it can save that system only
by steering 41,000
inpatient admissions on an annual basis away from UPMC and independent community
hospitals. [Read UPMC's Analysis of the PID Order Precluding a Contract With UPMC
To better understand what Highmark would propose now, look no further
than central Pennsylvania. There, Highmark
has a tiered system in which Geisinger, one of the finest integrated health
care systems in the state and often cited by President Obama as a model for the
nation, has been relegated—as solely determined by Highmark—not to the better
value (supposedly lower cost and better quality) “enhanced” tier, but to a
second, more expensive “standard” tier for patients trying to access Geisinger.
It should be no surprise that UPMC cannot and will not sign such a tiering-and-steering
contract, especially with a competitor intent on shoring up its hefty $2
billion plus investment in a competing health system. After all, Highmark
wouldn’t be investing all this money if it didn’t intend to fill WPAHS beds
with its own subscribers.
Highmark’s ads would have consumers believe that without a
Highmark-UPMC contract, many people will be denied access to this region’s
leading health system, UPMC. Nothing could be further from the truth. In fact,
85 percent of health care consumers in the region already have the option to
access UPMC’s services in-network through governmental programs or insurance
carriers other than Highmark. And based on our discussions with leading
employers, most if not all of them will be offering insurance options other
than Highmark alone when the commercial contracts between Highmark and UPMC
expire at the end of 2014. This means that virtually the entire insurable
population of western Pennsylvania will have the choice of full, in-network
access to UPMC by January 2015. To the extent that any Highmark subscriber uses
UPMC services out-of-network after 2014, Highmark itself will decide how the
additional costs associated with that use will be shared with subscribers.
Instead of trying to compel a contract with UPMC that clearly conflicts
with and undermines the plan that the PID approved for Highmark’s acquisition
of WPAHS, it’s time for Highmark to move on to planning a predictable and
patient-friendly transition period. We need to work together to ensure that
consumers can, if they desire, easily change their insurers or their physicians.
It’s also time for Highmark to join UPMC in reassuring seniors and other
vulnerable populations that their full, in-network access to UPMC will be
preserved, as UPMC and Highmark jointly advertised in December 2011 and January
Once Highmark decides to live up to its plans and assumptions submitted
to and approved by the PID to save WPAHS, the ad wars will cease, and we can all move on
to enjoy the innovation and lower costs of this new era in Pittsburgh health
Paul Wood is Vice President & Chief Communications Officer at UPMC.
Labels: Paul Wood, upmc