BREAKING: Pennsylvania Attorney General Resolves Long-Running Dispute between UPMC, Highmark

June 24, 2019
As the conflict between the UPMC health system and Highmark Blue Cross Blue Shield reached a moment of high tension, Pennsylvania AG Josh Shapiro brokered a deal to avert a care delivery breakdown

Pennsylvania’s governor and attorney general Josh Shapiro made a major announcement Monday that UPMC and Highmark have agreed to enter a 10-year contract that will extend access to UPMC facilities for Highmark-insured patients, averting a looming breakdown in access to patient care for patients in Pittsburgh and across western Pennsylvania.

As an article in KDKA2 online, the website of the CBS local affiliate station noted, “The announcement comes less than a week before a deadline that would cut off Highmark customers’ access to many UPMC facilities.” And it quoted AG Josh Shapiro’s tweet, in which Shapiro wrote, “@UPMC + @Highmark have agreed to enter into a 10-YEAR contract that will extend access to UPMC facilities to Highmark-insured patients. This historic, global deal will give patients a decade of stable care – protecting workers, seniors, cancer patients, children.”

As the KDKA2 report noted, “The contract will go into effect on July 1, meaning patients will not face any disruption in their care, says AG Shapiro. The five-year consent decree between the two health care providers was set to expire on June 30, which would have put hundreds of thousands of Highmark subscribers in jeopardy of losing access to UPMC facilities. Shapiro says there will also be a new foundation for going forward, and that the two health care giants will no longer be adversaries. Rather, they will act together to serve the public. Also, he said, unlike the former consent decree, this is an agreement between the two parties without government intervention.”

“As a result of these discussions, patients are no longer caught in the middle, and the power is returned to the consumers,” Shapiro said. “That’s why my office took action to protect the millions of Pennsylvanians who rely on UPMC for their health care and for their wellbeing. I could not be more grateful to these two companies; they were able to put aside their differences, even in the final hours of the existing consent decree and focus on a cause bigger than them.”

And an article in WTAE4 online, the website of the ABC affiliate, noted that “Attorney General Josh Shapiro announced Monday that UPMC and Highmark have a new contract that gives Highmark insurance customers in-network access to UPMC doctors and hospitals for the coming decade.” Mark Scolforo, who wrote the article for the Associated Press that was shared at WTAE online, reported that “Shapiro, who earlier this month lost a court decision in his effort to extend the companies' relationship, called the agreement a good deal for patients and the public. UPMC had opposed renewing their agreement in 2012 after Highmark purchased what's now Allegheny Health Network and became what UPMC viewed as a competitor in providing health services and insurance coverage. That led to a five-year consent decree that expires Sunday,” Scolforo wrote.

UPMC published a lengthy statement on its website. That statement is as follows:

“UPMC today announced that with Attorney General Josh Shapiro’s support and facilitation, it has reached an agreement with Highmark to enter into a long-term contract to provide Highmark members with the in-network access to the UPMC physicians and facilities they desire—not only in greater Pittsburgh and Erie, but across western Pennsylvania. This agreement includes an extension of the UPMC Children’s and UPMC Western Psychiatric agreements and provides for UPMC in-network access at the highest benefits levels.

“Over the past decade, the insurance market in western Pennsylvania has transformed into a highly competitive, multi-insurer, pro-consumer market with some of the lowest costs in the nation. In that same time, UPMC continued to invest in the world-class medicine and research that makes UPMC the indispensable provider of health care throughout Pennsylvania.

“Following the June 14 Commonwealth Court decision, UPMC held a productive, congenial meeting with Highmark to outline its offer to provide in-network access to the UPMC Hillman Cancer Center for Highmark members with a suspected or confirmed cancer or hematologic diagnosis. Highmark recognized—as do all—that the UPMC Hillman Cancer Center is as essential to the region’s well-being as specialty hospitals UPMC Children’s and UPMC Western Psychiatric. Those discussions then quickly expanded to other areas, and an agreement in the best interests of the patients and communities we serve was reached.

“UPMC believes in the importance of informed consumer choice and has always sought to ensure that when UPMC is part of any insurance network, those members have full access to UPMC without contractual terms used to discourage or limit the use of UPMC’s physicians and facilities. This important consumer issue was resolved in a collaborative fashion and UPMC’s network will now be available to Highmark members. UPMC appreciates that we were able to reach this agreement with Highmark on a long-term, in-network contract.

UPMC is grateful for the Attorney General’s leadership as the agreement announced today was built on a foundation of trust, compromise and collaboration. As always, UPMC remains committed to exceptionally serving the health care needs of the citizens of Pennsylvania.”

Meanwhile, Highmark also released a lengthy public statement on Monday afternoon, attributed to Highmark president and CEO David Holmberg. Here is that statement:

“Today's news about a contract between Highmark and UPMC fulfills the promise to our community that we at Highmark Health have strived to achieve for the last five years: Consumers and patients have two outstanding health systems, in addition to our many independent community hospitals, to choose from for their care.

“This announcement brings the certainty of health care access to thousands of people in our community. It marks a significant step forward for our region.

“On behalf of our employees, clinicians and all of those we serve, I'd like to thank Pennsylvania Attorney General Josh Shapiro for his leadership and advocacy in helping to broker this new day for health care in Western Pennsylvania.

“It's important to remember that five years ago Highmark took bold steps to preserve health care choice in this region by investing more than $2 billion in the exceptional care and services provided by AHN in the Pittsburgh and Erie regions, including a nationally recognized cardiac team that boasts the #1 heart transplant program in the state and a top 10 program in the country; a cancer institute that collaborates with the world renowned Johns Hopkins cancer center to offer leading-edge innovation and cancer treatment capabilities; and a women's health program that is setting new standards for the treatment of women with post-partum depression, among many other examples.

“We created AHN in service to the community and to preserve 17,000 health care jobs, a number that has grown to more than 20,000 today. We plan to continue growing AHN to meet the needs of patients throughout the region.

“Together, Highmark and AHN are recognized as national leaders in the development and delivery of a community-focused, value-based care model that focuses on keeping patients healthy, and providing effective health care options in convenient, close-to-home settings. This is the future of health care in our country and Highmark and AHN have been at the forefront of the transformation.

“While the contract terms and conditions between Highmark and UPMC will be finalized throughout the next few weeks, beginning July 1 all Highmark members will have full in-network access to UPMC if their health plan includes UPMC in their health care provider network.”

The despite between UPMC and Highmark had been building for years, and had become highly acrimonious, and had been receiving immense media publicity in western Pennsylvania. Attorney General Shapiro was able to broker the deal just days before UPMC plan members would have lost access to UPMC care delivery.

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