Dive Brief:
- In another bump in the ongoing saga between Highmark Inc. and the University of Pittsburgh Medical Center, Pennsylvania officials announced this week that they plan to take legal action against Highmark for reneging on an agreement to allow all of their Medicare beneficiaries in-network access to UPMC hospitals.
- Officials including the state's attorney general and insurance commissioner helped broker the deal between the two organizations this summer. A recently-introduced Highmark Neighborhood Blue Medicare HMO program that excludes UPMC providers in Western Pennsylvania from the plan prompted the state's action. The zero-premium plan was meant as a lower-priced alternative to its broad network Medicare Advantage options.
- The state advised UPMC not to seek legal action against Highmark and instead allow the state to enforce the agreement in court.
Dive Insight:
The feud between the largest hospital system and dominant insurance provider in Pennsylvania was supposed to have come to a halt at the end of June after a brokered transition agreement was finalized. It began in 2011 when Highmark decided to purchase West Penn Allegheny Health System, UPMC's largest competitor.
The terms of the agreement included allowing Highmark commercial policyholders to see some UPMC oncology providers; use UPMC emergency rooms at in-network rates and allow some chronically-ill patients to keep their doctors for a year. Beginning in 2015, only seven of UPMC’s hospitals will be in-network with Highmark, not including its flagship facility. Part of the June agreement also stated that Medicare recipients would also be allowed to keep in-network access at all of UPMC's facilities.
In the letters to the two organizations, state officials scolded them for their perpetual animosity. "Your continued discord has now resulted in us having to take legal action that will likely only heighten consumer confusion and alarm," officials wrote. "Our collective expectation is that both parties will stop trying to out-maneuver one another and instead work together to fulfill both the letter and spirit of the consent decrees."
Want to read more? You may enjoy this story on the Highmark Health gamble and the risks of insurer-hospital integration.