Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Upmc vs. Highmark Policy Experts Say Now's the Time to End the Warfare

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Upmc vs. Highmark Policy Experts Say Now's the Time to End the Warfare

Article excerpt

Twenty-one months from now, barring an unexpected thawing of the relationship, UPMC and Highmark will go their separate ways with ripple effects that will be felt throughout the region.

Local health policy experts say that should not be allowed to happen and suggest now may be the time for state intervention to require the Pittsburgh region's largest health provider and its largest health insurer to cooperate.

"They both need to exist in the community. They can't drive each other out of business. Neither can exclude the patients of the other," said Stephen Foreman, associate professor of health care administration at Robert Morris University.

The latest example -- UPMC effectively blocking Highmark Community Blue subscribers from continuing to see UPMC physicians -- illustrates the level of animus between the two health care giants that makes a reconciliation seem unlikely.

"It just seems wrong," said Martin Gaynor, professor of economics and health policy at Carnegie Mellon University.

"If UPMC would act as a nonprofit with a community mission, then we might not have this problem at all," he said. "The people on the UPMC board should take a good long look in the mirror and ask themselves if they're performing their duties to the organization and to its mission and not just to current management.

"You have to wonder if the board of directors is really in control."

While UPMC's dismissal of Community Blue subscribers has generated the latest wave of criticism, Mr. Gaynor and Mr. Foreman say the dynamic of one powerful insurer and one dominant provider is not healthy for the community, especially when the two spend so much time and money battling each other.

"It's clearly not a good situation," Mr. Gaynor said. "Even with the previous UPMC-Highmark pact, my feeling is that they were making decisions because it was to both of their mutual benefit and not ultimately to the benefit of the community.

"It's a pretty ugly mess, and it may be that the state stepping in and forcing their hand might be in order here."

It took an intervention by Republican Gov. Tom Corbett a year ago to broker an extension of the UPMC-Highmark agreement to 2015, an agreement that provides in-network access to UPMC physicians and facilities for Highmark's 3.1 million members in Western Pennsylvania.

One key public official says the issue is already on legislators' radar.

State Rep. and Democratic Caucus Chairman Dan Frankel of Squirrel Hill has been circulating a memo to colleagues about his plans to introduce a bill that would make illegal "anti-tiering" clauses that prevent insurers from offering lower cost insurance plans such as Community Blue.

"To me, it's a much bigger issue than the contract between Highmark and UPMC," he said, citing the nationwide increase in hospital charges. …

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