West-Penn Highmark reach a $475 million deal (Pittsburgh, Media: to buy, contractors, closing)

[gg]

Originally Posted by Enough_Already

If Highmark and UPMC do not contract, hundreds of thousands of UPMC patients and people insured by Highmark will be faced with having their healthcare disrupted or face significantly higher out-of-pocket costs. Given all three of these are non-profit, this situation is not working for the public interest. This is just one organization engaging in empire building trying to slow down another organization engaging in empire building. The rhetoric from all the players involved is just noise.

Could Highmark play a trump card with making an agreement with Cleveland Clinic and take over AGH?

Pardon my ignorance on this subject. I am not in the loop at all.

[Aqua Teen Carl]

Break up these health care cartel sons of ******* that parade around as if they're non-profit. Then we all would be much healthier as a society.

[greg42]

Originally Posted by h_curtis

Could Highmark play a trump card with making an agreement with Cleveland Clinic and take over AGH?

Pardon my ignorance on this subject. I am not in the loop at all.

The issue in question there is Highmark customers not having access to UPMC doctors. Because of the way UPMC is structured, many of those physicians simply won't be able to take Highmark coverage for payment beginning I think it's June or July 2012. It's not the first of the year, but somewhere in the middle.

Highmark is already taking over, effectively, West Penn Allegheny, the whole thing, AGH included. The bringing in of other partners really doesn't have any bearing on the fact that lots of Highmark customers may end up needing to switch doctors next year.

The next showdown to watch will be renewals; this will play out over the next 6 months or so. If Highmark retains most of their customer base, then UPMC may in fact need to back down because they will lose too much business not being able to accept Highmark payment. If instead Highmark loses a bunch of business to other insurance companies, then that will give UPMC the upper hand.

It's worth noting that this is not too different from what happened last time 10 years ago.

If you read this one article from Sunday, you'll know a good overview: UPMC, Highmark embroiled in classic bad splitup

[rhondee]

Switching doctors does not mean that there will necessarily be a disruption with one's health care.

Physicians retire or relocate out of state all the time or have even practised in one hospital system then jumped over to a competing hospital to practise there and no one has freaked out about the threat of patient safety from these types of transitions before.Many employers switch health plans as well, out of the necessity of cost savings for their companies to stay afloat with employees under new health insurance.This sometimes happens on a regular basis.

Patients who are under UPMC insurance have received treatment at WPAHS and other facilities where they are stabilized, then are made to transfer to a UPMC facility and no one has blinked an eye or raised questions at this protocol before. There was always a concern of proper hand off communication or ,if the transfer happened very quickly, the ability to convey diagnostic test results, etc. from one HC system to another . This process can be very fragmented and difficult with various HIPPA and consent authorizations needed from the patient. Many times it is faster to re perform the tests i/o tracking down results from another facility.This causes delay in treatment as well.
There are special patient groups who I think should be authorized to retain their current physician and services and who should not be forced to transition. They would be cancer patients undergoing treatment or other medically complex patients. Otherwise, I don't see how this is a detriment to patients who seek care from either system.

[Enough_Already]

"Doctors: UPMC-Highmark split would hurt care"

Doctors: UPMC-Highmark split would hurt care

I had a doctor move from one health system to another. It most certainly had a negative effect on my care. These situations hurt the people with health conditions the most. I expect there will be a few needless fatalities if this situation is not resolved.

[Enough_Already]

Originally Posted by greg42

The issue in question there is Highmark customers not having access to UPMC doctors. Because of the way UPMC is structured, many of those physicians simply won't be able to take Highmark coverage for payment beginning I think it's June or July 2012. It's not the first of the year, but somewhere in the middle.

Highmark is already taking over, effectively, West Penn Allegheny, the whole thing, AGH included. The bringing in of other partners really doesn't have any bearing on the fact that lots of Highmark customers may end up needing to switch doctors next year.

The next showdown to watch will be renewals; this will play out over the next 6 months or so. If Highmark retains most of their customer base, then UPMC may in fact need to back down because they will lose too much business not being able to accept Highmark payment. If instead Highmark loses a bunch of business to other insurance companies, then that will give UPMC the upper hand.

It's worth noting that this is not too different from what happened last time 10 years ago.

If you read this one article from Sunday, you'll know a good overview: UPMC, Highmark embroiled in classic bad splitup

We like to talk about the monopoly power of UPMC. That is certainly true. But Highmark enjoys a similar position in this area for health insurance. Both situations have pushed up costs for patients and employers in this area. Both organization have take actions toward empire building which have had negative effects on patient care.

[greg42]

Originally Posted by Enough_Already

We like to talk about the monopoly power of UPMC. That is certainly true. But Highmark enjoys a similar position in this area for health insurance. Both situations have pushed up costs for patients and employers in this area. Both organization have take actions toward empire building which have had negative effects on patient care.

I was mostly giving an overview as a specific reply, but I get what you're saying. I don't think there's anything in what you quoted that contradicts it either. There's not really a "good" to either outcome. The whole situation is a net negative for everyone. Short of some kind of intervention from the state or whatever what I stated is what it will be important to watch.

It's pretty obvious that Highmark's plan of action will be to work, perhaps quite aggressively, to retain its customers in the face of what appears to be additional competition, from insurers that were either not working at all in this market or previously didn't have contracts with UPMC. If Highmark is successful, they will have the upper hand clearly, because the net effect, barring a new contract, would be that UPMC would stand to lose a lot of Highmark patients.

If instead the other insurers win a decent chunk of business from former Highmark customers, then UPMC will retain the upper hand as far as access to its network, and Highmark will have to determine what their next step is. The other companies will all have access to West Penn Allegheny so it will instead leave Highmark as the entity with no UPMC, instead of, as in the past, insurers like Aetna which had no access to UPMC. Whether Highmark as an insurer can survive like that I don't know. It's an interesting bet to say the least. They're betting that they're not going to lose the customer base. As you say, this is just as monopolistic as UPMC's actions on the care side.

It's a little more serious it seems this time vs last. We could see intervention from the state if someone makes a big enough case that this is too detrimental for healthcare in the area.

[rhondee]

Originally Posted by Enough_Already

"Doctors: UPMC-Highmark split would hurt care"

Doctors: UPMC-Highmark split would hurt care

I had a doctor move from one health system to another. It most certainly had a negative effect on my care. These situations hurt the people with health conditions the most. I expect there will be a few needless fatalities if this situation is not resolved.

I'm sorry that you had a negative experience and that must have been scary for you.I did state above that people undergoing treatment should not be forced to transition, but for the vast majority of patients, I believe the move should not pose as a safety risk.

UPMC has been luring physicians away from WPAHS for the past decade and patients choosing to follow their own doctor have had to change health systems.I've never heard reports of potential patient safety risks while this was going on.Now that the shoe is on the other foot it has all of a sudden become a safety risk?

Sorry, but aside from the consideration of some special groups of patients who should stay within their current system, I think this fear has more to do with "revenue safety" and not patient safety.

[SlurmsMcKenzie]

We are nearing a point where all health systems will be electronic and required to share patient information with one another. Its coming soon and Western Pa will be ahead of the curve. So, there will be a day when changing doctors/hospitals will be less painful, hopefully sooner rather than later.

[Penguins Fan]

Originally Posted by Aqua Teen Carl

Break up these health care cartel sons of ******* that parade around as if they're non-profit. Then we all would be much healthier as a society.

Highmark is no cartel, and never has been. Highmark has faced insurance carrier competition in Western Pennsylvania for many years and is in direct competition with Capital Blue Cross in Central Pennsylvania.

UPMC operates a health care insurance plan in addition to their hospital network of more than 20 hospitals. Aetna, Health America, Cigna and United Health Care also offer health insurance coverage in Western Pennsylvania.

Ah, but emotions are so much easier to express than research.