Aetna, UPMC Pinnacle expand care agreement

An existing accountable care agreement between health insurer Aetna and UPMC Pinnacle has been expanded to include hospitals recently acquired by the hospital system.

Since 2014 the two entities have offered an accountable care arrangement for patients in Dauphin, Cumberland and Perry counties. The arrangement provides coverage for Aetna customers at hospitals within the UPMC Pinnacle system. In exchange for a limited network of hospitals for which patients are covered under the arrangement, insurance costs  are lower than they are under Aetna’s standard options.

As of October, the agreement has been expanded to include UPMC Pinnacle Carlisle, Hanover, Lancaster, Lititz and Memorial in York County and two associated physician groups.

Aetna originally partnered with Pinnacle before it was acquired by UPMC last year. Both Aetna and UPMC Pinnacle have agreed to expand that partnership.

“Aetna is delighted to grow our presence by offering access to UPMC Pinnacle’s expanded network,” Andrew Richard, vice president of Aetna Provider Networks, said in a press release. “Through accountable care relationships, we’re working closer than ever with physicians and hospitals to make health care more affordable while improving quality and efficiency.”

The plan has garnered interest from small-business owners with employees who mostly stay within the coverage area of the agreement. While services are limited outside of approved UPMC Pinnacle facilities, an Aetna spokesperson said that Aetna may suggest other options if a service is not offered under its coverage.

“If a particular service needed isn’t offered under UPMC Pinnacle’s network, Aetna will review the request and suggest other provider options,” the spokesperson said.

Ioannis Pashakis
Ioannis Pashakis covers health care and Lancaster County. Email him at ipashakis@cpbj.com.

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