Top Highmark Health execs say the insurer is ready for the end of the consent decree in 2019 between it and UPMC and expressed optimism that a coverage agreement could eventually be reached over Children’s Hospital of Pittsburgh and Western Psychiatric Institute.

The work over the past several years, including the establishment of the Allegheny Health Network and millions of dollars of investment in technology, services and providers, has been leading to that point, Highmark executives told business leaders Tuesday at the Pittsburgh Business Group on Health’s annual meeting in downtown Pittsburgh. Highmark Health President and CEO David Holmberg and others from the insurer were there to answer business leaders’ questions about the end of the consent decree.

Holmberg said that there’s now a choice between health care providers.

“With the end of the consent decree, you have two fine organizations who couldn’t be more differentiated in terms of value, with the Allegheny Health Network and Highmark, and volume versus maybe some of the other folks, and you have a choice in terms of what you want to do,” he said.

Less than 15 percent of Highmark members are using UPMC facilities, much less than in the past.

“That number continues to go down, so most of our members have already been through the process and have already transitioned,” said Anthony Benevento, senior vice president of regional markets at Highmark. “Our goal was not to make it a cliff in ’19, and we are pretty close to that now.”

The consent decree, brokered by state officials in 2014, means that Highmark members will no longer be able to access most UPMC facilities as in-network options after June 30, 2019. An agreement between UPMC and Highmark over care at Children’s Hospital of Pittsburgh runs through 2022, but Holmberg said he hoped a new agreement could be reached by then. Holmberg said he believed that all children’s hospitals across the country should be “nonpolitical” and added that Highmark gave millions of dollars to build the hospital.

“Children’s needs to be open to Aetna, Cigna, to United, to Highmark and certainly to UPMC,” Holmberg said. “We should never allow children to be pawns in any other game going on. So I believe that that will be resolved after 2022 and we’re fully committed to doing that.”

He also said he believed coverage of Western Psychiatric Institute also will be worked out sometime in the future.

“It’s best for everybody,” he said. “Whether it be Western Psych or some of these speciality areas, there’s such a need in the community. We believe we’ll be able to work together and figure that out.”

Holmberg was asked about the business community’s role in fostering an agreement.

“For whatever reason that access is denied, they should be pissed off,” Holmberg said. “They should do something about it. What you’ve got to do is vote with your people. But again, I’m working under the assumption that this will be resolved.”

The Pittsburgh Business Group on Health reached out to UPMC for its CEO to talk but the organization’s officials have yet to hear a response, they said. UPMC also declined comment for this article.

Paul J. Gough  –  Reporter

Source: Pittsburgh Business Times

Dec 5, 2017, 2:20pm EST Updated Dec 6, 2017, 10:43am