UPMC, Highmark reach deal on hospital access

UPMC Pinnacle Hanover is one of several midstate hospitals available to Highmark subscribers under the new deal.

A new deal between UPMC and Highmark promises to extend in-network access for Highmark customers looking for treatment at select UPMC hospitals and treatment centers, including facilities in Central Pennsylvania.

The deal between the two health care giants, announced Thursday by Gov. Tom Wolf, calls on UPMC and Highmark Inc. to continue coverage at specific hospitals and treatment centers past the expiration next year of a court-mandated consent decree signed in 2014.

The agreement also extends the arrangement to a number of UPMC hospitals in Central Pennsylvania.

“This landmark agreement means consumers of both companies will have in-network access to facilities that provide one-of-a-kind services,” Wolf said in a statement Thursday. “This is medical care that simply is not available anywhere else in the region, and denying affordable access to this vital care is just not acceptable. I am pleased that with this agreement access will continue.”

According to the governor’s office, the deal between the two companies will allow Highmark customers to seek treatment at “one-of-a-kind” hospitals and facilities in specific regions, including the Western Psychiatric Center and UPMC Center for Assistive Technology in Pittsburgh.

The deal also continues service for Highmark customers at select hospitals “that are the only hospital in a community.”

Midstate hospitals listed by the governor as covered in the deal include: UPMC Pinnacle Carlisle, formerly Carlisle Regional Medical Center; UPMC Pinnacle Lancaster, former Lancaster Regional Medical Center; UPMC Pinnacle Lititz, formerly Heart of Lancaster Regional Medical Center; and UPMC Pinnacle Memorial, formerly Memorial Hospital of York; and UPMC Pinnacle Hanover – all of which were acquired by UPMC in its merger with PinnacleHealth.

Most of the midstate facilities, however, are not the only hospitals in their communities. York County, for example, is served by WellSpan York Hospital, while Lancaster County is also home to Lancaster General Health/Penn Medicine and WellSpan Ephrata Community Hospital. Geisinger Holy Spirit, meanwhile, is in Cumberland County.

“What the agreement announced today is intended to do is make sure everyone has access to unique services,” said Ronald Ruman, communications director for the state Insurance Department. “The agreement today is to protect consumers, making sure everyone has access to vital services and facilities when there aren’t alternatives available.”

Ruman stressed the deal was facilitated by the governor but is solely an agreement between the two companies, not an agreement between either party and state government.

Healthier relations

Discussions between Highmark and UPMC began in mid-August of last year. The deal extends coverage by Highmark at most of the UPMC facilities listed in the deal five years past the June 2019 expiration of the consent decree.

“I think it is definitely a good sign for our customers,” said Tom Fitzpatrick, senior vice president of provider contracting and relations at Highmark. “I think it adds clarity and assurances that they’ll continue to have in-network access to these facilities that UPMC has purchased.”

Fitzpatrick added: “It’s obviously always our hope that we’ll be able to collaborate and bring to the market affordable, quality health care products and services.”

In a statement UPMC executive vice president David Farner said: “This agreement provides clarity regarding the unique and highly desirable medical services only available at UPMC’s world-class facilities.” UPMC Pinnacle declined to provide further comment.

The deal comes among fears the midstate could see a repeat of the bitter battles between Highmark and UPMC in Allegheny County after the formation of UPMC Pinnacle.

Last November, Highmark delisted some midstate facilities acquired by UPMC from coverage under one of its Obamacare marketplace plans, prompting UPMC Pinnacle to suggest patients looking for treatment at its centers should instead “consider Capital Blue Cross marketplace plans.”

Editor’s note: This story has been modified from the original to include other Central Pennsylvania hospitals that serve communities mentioned in the initial announcement from the governor’s office.


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