Dive Brief:
- After years of feuding, bitter rivals Highmark and University of Pittsburgh Medical Center (UPMC) reached a state-brokered agreement June 24 on issues related to ending their contract. Pittsburgh-based Highmark is western Pennsylvania's dominant health insurer, and UPMC is the dominant health system.
- The “new” end-of-contract transition plan between Highmark Health and UPMC looks a lot like the separation agreement that has been discussed all along, but with some key improvements for consumers staying with Highmark coverage.
- Gov. Tom Corbett and other state officials mediated a transition plan with Highmark and UPMC, but their executives never met face-to-face during three weeks of talks, underscoring their acrimonious relationship. The governor's office is expected to release further details today.
Dive Insight:
Under consent decrees finalized June 24, Highmark commercial policyholders, who are not in Medicare, Medicaid or CHIP, may continue to see certain UPMC oncology specialists, according to a Post-Gazette source. Highmark customers also may use all UPMC emergency rooms at in-network rates. Chronically-ill Highmark customers also will be able to keep their doctors, under certain circumstances, for as long as a year, under a “safe harbor” provision, a source said.
Unless there is revision or a new contract, the consent decrees will remain in effect for five years, and arbitration would settle any conflicts between the two organizations over their enforcement.
Starting Jan. 1, 2015, seven of UPMC’s 16 major hospitals will be in-network for Highmark customers, while UPMC's remaining hospitals, including its urban and flagship facilities, will be out-of-network. The Post-Gazette described that as "a bitter pill" to swallow for Highmark members who had expected in-network access to UPMC’s East End hospitals — and for those anticipating that UPMC would capitulate in the face of ongoing pressure from patients, politicians, business groups and Highmark itself.