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UPMC, Highmark agree on limited basis to continue care for seriously ill

By Alex Nixon and Brad Bumsted
Wednesday, June 25, 2014, 6:18 a.m.
 

HARRISBURG — Elected officials in Harrisburg reached a deal with health care giants UPMC and Highmark Inc., but it wasn't what the insurer and thousands of its members in the Pittsburgh region were hoping for.

Sources told the Tribune-Review that Gov. Tom Corbett and Attorney General Kathleen Kane mediated a transition plan with the bitter rivals, whose executives never met face-to-face during three weeks of talks, underscoring the acrimony in their relationship.

The plan would benefit only a limited number of Highmark subscribers. It allows seriously ill Highmark members under the treatment of UPMC doctors to receive care, and, for only a limited time, when a reimbursement contract between the two feuding companies expires at the end of the year.

It also provides Highmark members continued access to hospitals in rural areas outside of Pittsburgh, solidifying a decision that the companies made when Corbett brokered an extension of the contract two years ago.

The agreement, laid out in separate documents signed by UPMC and Highmark officials, makes clear that there will not be another extension of the contract, which gives millions of Highmark customers less-costly, in-network access to UPMC hospitals and doctors through Dec. 31, the sources said.

Despite pressure from Highmark, the state's largest health insurer, and advocacy by politicians, patients and others, UPMC's hospitals and doctors in Allegheny County and four surrounding counties will become out-of-network for Highmark subscribers, starting Jan. 1.

Only UPMC's rural hospitals — Northwest, Bedford, Hamot, Horizon and Altoona — along with doctors and associated clinics of those hospitals, will remain in-network next year. Two specialty medical centers in Pittsburgh — Children's Hospital of Pittsburgh and Western Psychiatric Institute and Clinic — also will be in-network. It does not include Magee Womens Hospital.

Medicare and Medicaid recipients will continue to have in-network access to all UPMC hospitals and doctors.

UPMC cancer centers will be open to Highmark members as long as the insurer approves the treatments.

Patients in a course of treatment for any serious illness at UPMC when the contract expires will be allowed to continue for a transition period to ensure their care is not abruptly disrupted, the sources said. Examples of treatment that would qualify are cancer and a pregnancy.

Corbett, a Republican, and Kane, a Democrat, are expected to detail the agreement on Thursday after postponing a Wednesday announcement to iron out last-minute details. The deal was inked on Tuesday, but a source said officials with Corbett and Kane wanted to give the agreement a final review and coordinate their statements and a news release.

Jay Pagni, the governor's press secretary, and J.J. Abbott, Kane's spokesman, declined to comment. Officials with UPMC and Highmark also declined to comment.

State Sen. Don White, R-Indiana, who is chairman of the Banking and Insurance Committee, opposed bills in his committee that would have forced UPMC and Highmark into a contract.

“For several years, I have been publicly calling on UPMC and Highmark to set aside the rhetoric and develop a clear and concise transition plan so the citizens of Western Pennsylvania can prepare for the contract expiration on Dec. 31,” White said. “While this transition may be complex in the short run, I truly believe Western Pennsylvania is on the doorstep of experiencing true competition in the health care marketplace in both the insurance and health care provider markets.”

At a march Downtown on Wednesday organized by a labor union battling UPMC to represent hospital workers, protesters decried the transition plan.

“We look to elected leaders to show courage, but (Corbett's) plan is anything but ‘patients first,' ” said Gabe Kramer, 39, of Squirrel Hill.

The Service Employees International Union's Healthcare Pennsylvania unit sponsored the protest. Participants marched from Corbett's regional office on Fifth Avenue to Kane's in the County Office Building to deliver letters demanding that UPMC be forced to contract with Highmark. Wearing a raincoat, Highmark subscriber Joanna Bouldin, 39, of Dormont addressed a crowd bearing bright orange signs.

“I woke up one morning five years ago with back pain so severe I couldn't move,” she said. “I finally have a team of doctors I love and trust, but only half of them will be covered in January. These are not relationships that can be replaced with a help line.”

Corbett this month urged UPMC, the largest hospital system in Western Pennsylvania, and Highmark, the state's largest health care insurer, to sit down with the state insurance commissioner and Health secretary to come up with a transition plan.

The governor invited Kane to join the meetings. The attorney general's office has a consumer protection role, and Kane has said she has worked toward a resolution between UPMC and Highmark for more than a year.

Insurance Commissioner Michael Consedine previously required Highmark to file by July 31 a transition plan describing where patients would be able to continue to receive care. Employers and others complained that the information was needed more quickly.

Physicians were pleased that Highmark and UPMC had agreed to a plan, according to the Allegheny County Medical Society.

“From the beginning, physicians were most concerned about continuity of care for their patients,” Dr. Kevin Garrett, president of the medical society, said in a statement. “The work completed through the leadership team spells this out for Highmark patients being seen at UPMC facilities and/or physician offices in the Pittsburgh region.”

Alex Nixon and Brad Bumsted are Trib Total Media staff writers. Reach Nixon at 412-320-7928 or anixon@tribweb.com. Reach Bumsted at 717-787-1405 or bbumsted@tribweb.com. Staff writer Megan Harris contributed to this report.

 

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