Fábregas: Highmark-UPMC deal feels like a divorce

Luis Fábregas
| Saturday, July 12, 2014, 12:01 a.m.

Now that the exasperating feud between Highmark and UPMC appears to be ending, we can agree on something: We feel like children of divorced parents.

We're happy that our parents stopped fighting and saying unkind things about each other, but we're smart enough to know it's only a matter of time before they start acting jealous or hostile. Then, we'll be forced to take sides, even though there's no doubt we love them both.

I don't mean to be a pessimist. It's fair to say this divorce ended quite amicably. That is, if you can forget the nasty court battles and the TV ads that became a cultural touchstone of sorts. Who can forget the exaggerated indignation of the woman in one commercial who pleaded, “You want me to go to what hospital?”

The better question is, what happens now? Will it be a happily-ever-after kind of tale in which the health care giants co-exist without constantly attacking each other? Will UPMC and Highmark stick to their promise of putting patients first?

The recent agreement the two parties reached suggests deep trust and a promising future. For one, Highmark members will be able to get in-network care at UPMC emergency rooms and cancer centers. And those who are in the middle of treatment at UPMC can stay with their doctors, something that squarely addresses the fears of thousands of patients. That's on top of continued access to UPMC-owned specialty hospitals such as Children's Hospital and Western Psych.

It's no wonder this “agreement” smells like a contract. UPMC, after all, gets the influx of Highmark members without a formal commercial contract.

It's wise to point out that those accessible UPMC emergency rooms contribute to about half of hospital admissions. So if you're treated in a UPMC emergency room and need hospitalization, you'll probably stay at that hospital. Extra points to UPMC for making it look as if it's maintaining access, when it probably will gain many more profitable inpatients paying out-of-network rates.

Don't get me wrong, I love the idea of putting “patients first,” as Gov. Tom Corbett suggested when the agreement was announced. Still, I couldn't help but wonder: Haven't patients been first all along?

UPMC and Highmark should consider not overusing the word “access.” Health care is not just about access. Just because you get your foot in the door doesn't mean you're getting quality care, let alone affordable care.

Highmark officials are trumpeting the agreement, saying its members “can access high-quality, affordable care.” But how do we know what's affordable and adequately priced when we don't know the price tag of most common medical procedures? The implication that an unlimited supply of doctors and hospitals translates into cheap, quality care is flawed.

Though competition can lead to better prices, let's not forget that you often get what you pay for. By the same token, a restricted roster of providers, as in the case of Highmark's CommunityBlue, doesn't mean that care is substandard.

If UPMC and Highmark keep their word and use the chance to compete as a chance to improve health care, patients indeed will be first. If they fail, they'll force us to take sides and love one parent more than the other.

Luis Fábregas is Trib Total Media's medical editor. He can be reached at 412-320-7998 or lfabregas@tribweb.com.

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