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UPMC extends health plan dominance over Highmark

Wes Venteicher
| Tuesday, Feb. 28, 2017, 6:54 a.m.
The UPMC sign atop the U.S. Steel Tower in downtown Pittsburgh.
Tribune-Review
The UPMC sign atop the U.S. Steel Tower in downtown Pittsburgh.

UPMC Health Plan continued to grow its membership in the second half of 2016, helping support its claim that it is the largest insurer in Western Pennsylvania.

Diane Holder, the health plan's president and CEO, said Monday that 35 percent of insured people in the 29-county region have chosen UPMC Health Plan – about 1.2 million people.

About 1,000 more businesses started offering UPMC Health Plan to employees in the last year than had offered it in the previous year, Holder said.

The insurer's share of enrollment in the individual insurance marketplace rose to 87 percent for the 29 counties in 2017, according to UPMC's analysis of enrollment data.

Much of the insurer's growth has come from people transferring from competitor Highmark Inc., according to the analysis. Highmark dominated the local insurance marketplace for years and captured most of the Affordable Care Act marketplace business when the marketplace launched in 2014. Highmark has raised its monthly premiums for the last two open enrollment periods, while UPMC Health Plan offered lower-priced plans.

Highmark spokesman Aaron Billger declined comment, saying the company doesn't traditionally comment on competitors' performance.

According to UPMC's analysis, about 150,000 people were enrolled in its individual health plans as of January. The number includes people who bought plans on the federal Affordable Care Act's individual marketplace, where income-based subsidies are available, and those who bought plans off of the marketplace, where subsidies are not available.

The analysis said Highmark's equivalent enrollment was about 23,000 in January.

UPMC Health Plan reported 32 percent growth in its Medicare Advantage population since 2014, with about 141,000 members in February. Highmark's Medicare Advantage enrollment in February was about 169,000, a decrease from 2014, according to the analysis.

“I think what we've figured out is this has been a very successful experiment,” Holder said of UPMC's decision to launch a health plan in 1996.

The UPMC system reported $106 million operating income for July through December, which was the first half of fiscal year 2017. It reported $616 million in net operating income.

Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or wventeicher@tribweb.com.

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