Highmark, UPMC prepare for end of contract

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The prospective UPMC-Highmark divorce is now a year away, but preparations already have begun for a post-contract afterlife.

Earlier this month, Highmark sent letters to 86 local independent physicians who refer a significant number of patients to UPMC facilities to let them know the insurer "will soon be contacting your commercial patients who have Highmark coverage" about what's to come if there's no contract, including the loss of in-network access to UPMC specialists.

"Ultimately, our goal is to help our members plan ahead to avoid the stress and hardship of last-minute transfer of care, or worse, significant out-of-pocket financial liability," wrote Thomas J. Fitzpatrick, Highmark vice president of provider contracting and relations, in a copy of the letter to doctors obtained by the Pittsburgh Post-Gazette.

The letter, in bold-faced type, also suggests that the physicians contact UPMC board members: "Your concerns regarding the impending disruption to your Highmark patients and to your practice's revenue are valid and should be heard."

Highmark spokesman Aaron Billger on Monday said the insurer has no immediate plans to contact patients, but "that doesn't mean we won't need to in the future."

Highmark's immediate and primary focus, he said, remains negotiating a contract with UPMC. "Highmark wants to have a contract. The people in Harrisburg do as well," he said.

For months, UPMC, the region's largest health system, and Highmark, the largest insurer, have waged full-out marketing campaigns in anticipation of the UPMC-Highmark contract expiring Dec. 31, 2014.

UPMC has steadfastly said it will break ties with Highmark in 2015 because the insurer became a competitor once it purchased the West Penn Allegheny Health System and began constructing its own provider network.

"UPMC believes both Highmark and UPMC owe the community clarity and cooperation as we move through 2014 toward a major realignment of our contractural relationships," said UPMC spokesman Paul Wood. "The business community and others in this region have clearly moved on."

Highmark's public pitch is that UPMC should continue contracting with Highmark, willingly or by legislative force, to give patients a choice and protect sometimes long-standing physician-patient relationships.

Employee benefits consultant James McTiernan of Triad USA, Downtown, said the Highmark letter sounds like an advisory for providers to plan in case there is no contract and that "it could be too late if you don't take appropriate measures to prepare."

But he said he and many others still think there will be a contract.

"It's in UPMC's favor to take as long as they can. If you're them, you can't show any sign of weakness in this negotiation," he said, adding that ultimately "I believe they need each other, no matter what they say."

UPMC, meanwhile, is ramping up outreach to its members with a new program -- unrelated to the nearing expiry of the contract, it says -- called "UPMC AnywhereCare," which features 24/7 online care for nonurgent ailments such as sinus infections, colds and the flu.

The letter, sent to MyUPMC members, promises "a quick response with a diagnosis and treatment plan, typically within 30 minutes, any time of the day or night."

While consumers may appreciate the convenience, Mr. McTiernan said such initiatives, by either side, may not win over consumers after their extensive public relations battle.

"At the end of the day, they both come out of this not looking very good after holding the community hostage over this," he said.


Steve Twedt: stwedt@post-gazette.com or 412-263-1963.

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