Right spirit, wrong deal: The Highmark-UPMC accord the region deserves

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That agreement between UPMC and Highmark heralded in the news last Thursday is not the one you were looking for.

The two health care giants reached a deal, forced by federal Judge Joy Flowers Conti, merely to stop suing each other over issues of antitrust. If only they could reach an accord on the issue of trust.

That deal would be the real breakthrough, an extension beyond 2014 of the contract between health insurer Highmark and medical network UPMC, but it remains elusive -- a disservice to the people in the region whose personal donations and state-granted tax exemptions helped build the Allegheny Health Network and the UPMC health system, both nonprofit public charities.

Now that the competing hospital networks are married to separate health insurance providers, UPMC refuses to extend the contract to allow regular Highmark customers in-network access to most of its hospitals.

Many health care providers profess a desire for competition, but closing the region's largest health network to the region's largest segment of insurance customers is not about expanding competition. It's aimed at driving a competing health insurer -- and possibly its hospital affiliates -- out of the marketplace.

Yet UPMC is too pervasive, too skilled and too valued by patients to have to worry about losing out under true competition. With more than 20 hospitals, 400 clinical locations and 55,000 employees (it does have them, regardless of its parsing of a legal technicality), UPMC is sitting in the health-care driver's seat.

Its competing UPMC Health Plan is growing as an insurance subsidiary. Assorted national insurers have entered the market and also pose competition to Highmark. From UPMC's perspective, all this is good.

UPMC also points out that, despite the end of its main contract with Highmark after next year, its in-network door will stay open to Medicare and Highmark Medicare Advantage beneficiaries; children covered under the state's CHIP program, including those with Highmark policies; regular Highmark customers at Children's Hospital, Western Psychiatric Institute & Clinic and certain UPMC cancer services; and regular Highmark customers at UPMC Altoona, UPMC Bedford Memorial and UPMC Northwest.

That's a lot of Highmark customers who will still have in-network access. Couldn't UPMC leave the door open for the rest? That would be worth a bigger headline at the top of Page 1.


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