Chronic Ailment | Opinion | Pittsburgh | Pittsburgh City Paper

Chronic Ailment

This time, treating Highmark and UPMC's cranial swelling may be tougher

After a year-long remission, Western Pennsylvania is due for a relapse of Health Care Derangement Syndrome, thanks to Highmark's acquisition of the Western Pennsylvania Allegheny Health System (WPAHS). The state's Insurance Department approved that deal this spring, and one symptom — nausea-inducing statements from health-care giant UPMC — has already appeared.  

A new TV spot features UPMC board chair G. Nicholas Beckwith III (though the ad identifies him as "Nick," 'cause he's one of us) making his case. "Highmark has said it will deny patients the care of UPMC by pushing them into Highmark's new hospital network," he warns. UPMC suspects Highmark of pulling a bait-and-switch, promising access to UPMC but shunting patients to its own facilities. And if anybody's gonna push patients away from UPMC, it's gonna be UPMC itself. "UPMC cannot sign a contract with Highmark that limits your access," Beckwith says. Limiting your access by not signing a contract, meanwhile, is apparently fair game.

Faced with the same feverish rhetoric we saw in 2011, it's tempting to reach for the same cure. Last year, Gov. Tom Corbett compelled UPMC to extend its contract, ensuring its services would be "in network" for Highmark customers through 2014. 

Yet the politics may be shifting. Corbett's own Insurance Department signed off on Highmark's plan, while making this acknowledgement: "In order for Highmark's ... strategy to work, it must: (i) incentivize patients to select West Penn and other aligned hospitals instead of UPMC; and (ii) incentivize physicians to use [those] hospitals instead of UPMC." Otherwise, the department ruled, "It is unlikely that Highmark can attract sufficient numbers of patients to West Penn to make the affiliation successful."

And it's not just Corbett officials echoing Beckwith's reasoning. 

"I never thought I would say this," state Sen. Jim Ferlo (D-Lawrenceville), one of UPMC's sharpest critics, said in a statement, "but I appreciate UPMC's being up front ... about its intent to not renew its contract." 

Was Beckwith's fever contagious? Not at all, Ferlo told me. Now that Highmark's acquisition was approved, he says, "People need to understand the new sandbox we're playing in." 

While the Insurance Department took no official position on renewing Highmark's contract with UPMC, it added that "continuation of such a contract may, based on [Highmark's] projections, delay West Penn's financial recovery."

If that's true, Ferlo wonders — and if we care about preserving health-care jobs and choice in providers — how badly should we want the contract to be renewed? "Highmark can't have it both ways," he says.

I asked Highmark spokesman Aaron Billger about that, and about how the health-care landscape had changed since the last UPMC/Highmark battle.

"[O]pen access to all community assets — regardless of a patient's insurance card — forms the proper basis of customer-focused competition," his emailed statement read in part. "UPMC professes to support competition, but it really wants its own self-serving brand of competition." 

Highmark's brand of competition is just as self-serving, naturally. How many insurers who don't own hospitals, after all, espouse a utopia where your insurance card doesn't matter?

While no fan of Highmark either, Ferlo wants to make a UPMC/Highmark duopoly work, by ensuring WPAHS gets the patient volume it needs. He also wants to make the system accountable. "Obamacare" reforms, he notes, require hospitals to meet numerous requirements — involving charity care and other needs — or lose their non-profit status. That, says Ferlo, gives the community badly needed leverage. 

Currently, says Ferlo, "it's not clear there's a vehicle for the community to dialogue with Highmark and UPMC." The solution is creating "a concerned-citizens' group," to demand the providers address, say, the region's above-average infant mortality. 

It would be nice if patients were no longer just pawns. But will injecting some democracy into the health-care system be enough to cure the disease?

Highmark and UPMC act like rivals, but they grew up as a pair of conjoined twins. Nearly one-third of UPMC's net patient revenue came from Highmark, while UPMC provides nearly half of the region's hospital services — including those Highmark subscribers rely on. Given UPMC and Highmark's dependence on each other, and our dependence on both, separating them seems risky. Especially because, while they have two brains between them, there only seems to be one heart.