Highmark Blue Cross Blue Shield maintains readiness for meaningful UPMC contract discussions

April 8, 2014

“No meaningful progress” to maintain affordable access for Western Pennsylvania residents

PITTSBURGH, April 8, 2014 /PRNewswire/ — In a status update concerning contract discussions with the University of Pittsburgh Medical Center (UPMC), Highmark Blue Cross Blue Shield today said no meaningful progress is being made. Meanwhile, questions about the status of a Highmark and UPMC contract continue to be asked by area employers, health plan members, elected officials and the community at large. The company stressed that it stands ready to negotiate with UPMC.

“There are few local issues more important to the people of Western Pennsylvania than the resolution of the contractual dispute between Highmark and UPMC,” said Deborah Rice-Johnson, president of Highmark Health Plan. “Unfortunately, despite numerous formal and informal attempts to talk with UPMC executives, they remain unwilling to engage in even the most basic discussions for the benefit of our community. UPMC’s position risks disrupting health care services to hundreds of thousands of Pennsylvania residents. Together, we can do better, and the time to act is now.”

UPMC’s refusal to negotiate a new contract with Highmark is not the only issue. UPMC also has refused to finalize contracts that would provide affordable access to sole community and specialty providers: UPMC Bedford, UPMC Northwest, Western Psychiatric Institute and Clinic and certain UPMC oncology services. This lack of action is jeopardizing community health care that was assured in the governor’s mediated agreement from 2012. In addition, UPMC continues to delay positively advancing contract negotiations regarding UPMC Altoona. This undermines the intent of the attorney general’s office that approved the UPMC acquisition of Altoona Hospital under the condition of a contract with Highmark. At the governor’s direction, Highmark has been meeting weekly with representatives of UPMC to finalize these contracts since July 2012, but UPMC has not signed.

Meanwhile, UPMC has actively selecting populations that are to its benefit to have Blue plan contracts. For example, after promoting that there would be no contract with Highmark, UPMC claimed it wants one between UPMC Hamot in Erie, Pa., and Highmark – effectively saying the Erie community, but not the greater Pittsburgh area, should be awarded affordable access to UPMC.

“We have continued to tell UPMC that we will negotiate a system-wide contract,” said Rice-Johnson. “With their refusal to sign the contracts for community and specialty providers, which is almost two years overdue, it’s difficult to move forward with new contracts.”

UPMC has indicated it would seek contracts directly with other Blue Cross and Blue Shield plans on a case-by-case basis so that employees from companies based in another part of Pennsylvania or out of state could have access to UPMC hospitals. The Blue Cross and Blue Shield Association has confirmed that the regulations governing Blue plans restrict plans from contracting with hospitals and doctors located outside of their Blue Cross and Blue Shield-licensed territories. Therefore, without a contract between UPMC and Highmark, more than 275,000 people who are insured by Highmark or other Blue Cross and Blue Shield plans across the nation will no longer have in-network access to UPMC.

“It is unacceptable for UPMC to selectively pick and choose who has in-network access to its hospitals,” said Rice-Johnson. “Highmark stands ready to work with UPMC on a system-wide contract that would improve the quality and cost of health care for the entire region. However, the time for discussion is rapidly coming to a close because transition plans must be made. We continue to believe that the community deserves affordable in-network access to the hospitals that make up UPMC and were created by taxpayer dollars and community contributions. We are acutely aware of the marketplace disruption that UPMC is causing and support the strong business and community sentiment that we should be working with UPMC to focus on the health of all Western Pennsylvanians.”

About Highmark Inc.
Highmark Inc. is among the largest health insurers in the United States and the fourth-largest Blue Cross and Blue Shield-affiliated company. Highmark and its diversified businesses and affiliates operate health insurance plans in Pennsylvania, Delaware and West Virginia that serve 5.2 million members. Its diversified health businesses serve group customer and individual health needs across the United States through dental insurance, vision care and other related health businesses. Highmark is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. For more information, visit www.highmark.com

About Highmark Health
Highmark Health is a diversified health and wellness enterprise based in Pittsburgh that employs 38,000 people and serves 35 million individuals, making it the third largest integrated health care delivery and financing network in the nation. A Pennsylvania nonprofit corporation, Highmark Health is the parent company of Highmark Inc., which, directly or through its subsidiaries and affiliates, provides health insurance, dental insurance, vision care and other related health products and services to customers. Highmark Health is also the parent company for an integrated health care delivery network that includes seven hospitals, physician organizations, a group purchasing organization and ambulatory surgery centers. For more information, visit www.highmarkhealth.org

SOURCE Highmark Blue Cross Blue Shield

Source: PR Newswire

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