Highmark and UPMC saga draws to a close with publication of final transition plan

The Pennsylvania Insurance Department has posted the final transition plan for consumers as the contract between rivals Highmark and UPMC comes to an end on Dec. 31, 2014.

The long running conflict between UPMC and Highmark in western Pennsylvania had been closely watched as a potential cautionary tale of what can happen when insurers and health care providers begin integrating vertically into each others’ markets. In the UPMC-Highmark conflict, insurer Highmark purchased the then struggling Allegheny Health Network hospitals that competed with UPMC hospitals for patients. UPMC’s network contains several of the leading must-have academic medical centers in the region, and it was now less interested in giving Highmark insurance plan beneficiaries favorable rates for healthcare services performed by its physicians and at its facilities after Highmark began competing with it directly.

Lawsuits, allegations of misleading advertising claims about each other and physician poaching followed. Eventually the state stepped in.

In June, Governor Tom Corbett and Attorney General Kathleen Kane announced that Highmark and UPMC had reached a comprehensive transition agreement that covered how and where patients could receive health care after the contract between the two organizations expires in 2015. After all that had happened, neither side was willing to sign a new contract with the other.

According to the Pennsylvania Insurance Department, the final transition plan which it published on its website had undergone intensive financial and legal review, which focused on consumer concerns about being unable to access certain care at UPMC if they had a Highmark insurance plan.

“The final plan specifically outlines the process for safeguarding consumers’ health care and minimizing any patient disruption,” Department of Health Secretary Michael Wolf stated in the press release.

Highmark’s transition plan is available online by going through the Insurance Department’s website, insurance.pa.gov, or by clicking on a newly established site, StayInformed.pa.gov.  It includes provisions such as allowing Highmark members in-network access to UPMC emergency care and cancer care, as well as allowing established patient/physician relationships to continue even if they patient is a Highmark member and the physician works for UPMC.

The majority of Highmark’s insurance plans – the Community Blue products – will also become tiered-benefit designs that allow access to specified UPMC providers on an in-network basis.