On June 24th, 2019, the Pennsylvania Attorney General announced that he has brokered a relationship between Highmark and UPMC. The organizations agreed to a 10-year contract offering full in-network access to Highmark members in certain health products that include UPMC in Pittsburgh and Erie.
We released the following statement from David Holmberg, Highmark Health President and CEO
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.
What does it mean for me right now?
- In WPA, beginning on July 1st2019, all Highmark members in broad access products like PPO Blue and Blue Card will have full in-network access to all UPMC facilities and doctors.
- In WPA, members in high performing or tiered products such as Community Blue Flex or Connect Blue are already in a high-quality lower cost plan. Members in these products will not have access to all UPMC facilities or doctors on July 1st Certain services (like exception hospitals and some community oncology services) will be in-network. Other facilities and services (like Hillman and Passavant) will still be out-of-network. However, members will have affordable out-of-network protections for emergency department services at all UPMC facilities. As more details become clear there will be specific outreach to members to clarify how this decision affects them.
Freedom Blue / Security Blue Members:
- The announcement of an impending contract with UPMC means that your plan’s coverage includes continued in-network access to UPMC.
MA Community Blue Members in WPA:
- You are in a high-quality, lower-cost Medicare Advantage plan that does not include UPMC as an in-network provider.
- The contract announcement doesn’t affect plans like Community Blue.
- Community Blue PPO can continue to enjoy UPMC out of network benefits as they have in the past.
What about Children’s Hospital?
This includes a 10-year extension of Children’s Hospital contract for 10 years starting on July 1, 2019.
What about Western Psychiatric Institute and Clinic?
This includes a 10-year extension of Western Psych contract for 10 years starting on July 1, 2019.
Will all of the planned AHN projects in the community continue?
Absolutely. Our plans will continue. We have made commitments to building an AHN community-focused network that will reinvent health care for consumers. We are committing to driving change in how care is delivered at the community level.
Will this change your strategy in investing in AHN and other health systems?
Not at all. We are focused on doing what’s right for our members and the community. Competition in health care will help drive lower costs, higher quality and innovations in care.
What does this mean for access to UPMC hospitals in other regions, like central Pennsylvania?
This agreement is focused on Western Pennsylvania and does not impact other regions.