Dive Brief:
- Pennsylvania Gov. Tom Wolf and Attorney General Kathleen Kane are asking the state court to press Highmark Inc. and UPMC into binding arbitration, accusing both companies of breaking the state-brokered consent decree they agreed to last June.
- The complicated rivalry between the two healthcare organizations has most recently resulted in UPMC announcing an end to their in-network access for Highmark's Medicare Advantage patients beginning in 2016.
- Highmark told the media it would welcome enforcement of the decree, while UPMC is questioning the state's request for arbitration.
Dive Insight:
A former contract that had provided Highmark enrollees with in-network access to UPMC providers ended on Dec. 31, leaving only the consent decree to ease remaining coordination for continued UPMC access for specific medical treatments.
Following other disputes, UPMC appeared to have crossed the line with onlookers this month with its plan to end in-network access for seniors enrolled in Highmark's Medicare Advantage coverage.
As triblive.com notes, Wolf and Kane are calling the move a direct violation of the consent decree, which was intended to safeguard the "vulnerable populations" being impacted. Wolf described the plan as "the final straw" in the discussions.
Highmark spokesman Aaron Billger told the media the company is reviewing the motion for arbitration but that it would “continue to work cooperatively with the commonwealth to protect consumers.”
“There needs to be certainty in the marketplace, and the confusion must end. But it's disappointing that it takes litigation,” he said.