Dive Brief:
- University of PIttsburgh Medical Center (UPMC) says an analysis it performed using CMS data, census data, and Pennsylvania Department of Human Services data indicates the insurer has supplanted rival Highmark as the top health insurance provider in Western Pennsylvania.
- UPMC says its health plan enrollment increased from 813,000 in 2014 to 1,095,000 in 2016, while Highmark's enrollment during that time decreased from 1,419,000 to 1,092,000.
- Highmark did not indicate whether it agreed with the finding, saying it would announce its enrollment numbers in the coming weeks and does not comment on a competitors' enrollment.
Dive Insight:
If UPMC is correct, experts note two major points about the data: One is it indicates a major shift in the region's market dynamics.
Five years ago, Highmark was the undisputed regional leader with 60% of the market. Now, UPMC and Highmark each have about 28% of the market while another 29% belongs to other competitors. “I think what we've moved from is one of the least competitive markets to one of the most competitive markets in the nation,” Trib Live quoted UPMC Health Plan CEO Diane Holder.
The second major point, however, is some of UPMC's growth comes from the ACA marketplace -- business that may not equate to increased income. In addition, it's business Highmark may not have wanted after losing $318 million on its ACA business in the first half of 2015. The carrier raised its premiums for 2016 and allowed UPMC Health Plan to have the least expensive silver plan.
Meanwhile, UPMC faces an antitrust lawsuit claiming it conspired to push a competitor from the workers’ compensation cost containment services market, Law360 reports.