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CPBJ Extra Blog

Highmark has a new firewall

By ,

Because you and I are both so busy reading about the debacle that is playing out in D.C., I'll keep this short.

You will recollect that Pittsburgh-based insurer Highmark has forged into the provider world by acquiring West Penn Allegheny Health System and subsequently announcing the formation of Allegheny Health Network. The situation has some inherent tensions, which necessarily merited and received scrutiny from the Pennsylvania Insurance Department. One of the conditions of PID's approval was that Highmark enact a firewall policy, and that has now happened.

Highmark has, and I quote, "adopted a policy and set of procedures that safeguards competitively sensitive information from disclosure between the health insurance and provider services arms of its new integrated delivery network." It will submit a yearly report on the subject to PID, "which will ensure compliance and make the report publicly available."

That begs the question, of course, of what that policy is. According to Highmark's news release, the Competitively Sensitive Information Policy is supposed to "ensure that contracts, claims, rates, negotiations and other data is not disclosed between Highmark Health Services — the insurance subsidiary and Allegheny Health Network — the provider services subsidiary for inappropriate purposes."

This filing goes into a lot more detail, with lots of examples.

Here's one: "John is Associate Council at AHN and one of his responsibilities is to negotiate the terms and conditions of third party payer contracts. After a long and protracted series of negotiations, John successfully reaches a good deal for AHN physicians, and concludes the contract negotiation with Acme Health Insurer. That afternoon, John has lunch with his friend Ben who works at Highmark Health. John cannot discuss the negotiations, his thoughts and impressions, and the results of the negotiation with Ben because sharing the information would violate this Policy and compromise Competitively Sensitive Information."

Think it'll work?

• • •

Bodes well for nursing schools, I'd say: "Between 2011 and 2012 alone there was a 22.2 percent increase in enrollment in RN to BSN programs and a 3.5 percent increase in enrollment in entry-level BSN programs."

• • •

Not long ago, the three local Health Management Associates hospitals were ushered back in network for Gateway Health Medicaid plans. Therefore, I found this article interesting. It's about 10 Mississippi HMA hospitals that are out of network with Blue Cross & Blue Shield of Mississippi; the governor issued an executive order for BCBS to reinstate them, and a U.S. District Court judge has temporarily blocked it.

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Finally, prettiest infographic you're likely to see this week on recent health IT hiring, I'd guess. And wow, there's a lot of outsourcing.

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