Following the Commonwealth Court`s decision of June 14, UPMC held an ingeniously productive meeting with Highmark to outline its offer to access the UPMC Hillman Cancer Center for Highmark members with a presumed or confirmed diagnosis of cancer or hematological. Highmark understood – as everyone else – that the UPMC Hillman Cancer Centre is as important to the well-being of the region as the UPMC Children`s and UPMC Western Psychiatric clinics. These discussions quickly spread to other areas and agreement was reached in the best interests of the patients and the communities we serve. “As part of the agreement, they (community blue members) are being cared for in all emergencies,” Holmberg said. “If they decided to go there themselves, we would have to understand the peculiarities.” “This agreement literally saved my husband`s life,” said Lara Larson of Warren, Pennsylvania. “If this agreement had not been reached, it would not be here. The following year, our experience was fantastic. My husband sees the doctors who know him and who know his history. It was huge to mitigate it, and this order of approval gave me access to the resources and collaborators my husband needs to look after him. The agreement, which will take effect on July 1, will ensure that Highmark Medicare Advantage and commercial listings have access to 11 UPMC hospitals and affiliated providers in the network.
Highmark said it and UPMC will conclude the terms of the contract in the coming weeks. Attorney General Shapiro worked for two years with UPMC and Highmark to resolve the issue of expiring approval orders and to avoid further damage to the public. When negotiations resulted in a result, Attorney General Shapiro filed a petition against UPMC in February 2019 to amend the approval decrees. Before the Commonwealth Court decided on June 14, 2019, that the state could not amend these agreements, Attorney General Shapiro had already begun rigorous negotiations with the leaders of UPMC and Highmark to reach this agreement. “Without this agreement, nearly 1.9 million Western Pennsylvanians would have lost access to health care by their doctors,” said Attorney General Shapiro. “Thanks to the patients who came forward and told their stories, we turned the tables and secured a 10-year agreement that puts people in western Pennsylvania first. I have heard of so many people who have been able to keep their doctors and care teams, which is even more important in the event of a public emergency. The unexpected agreement resolves a bitter and long-running struggle between rival health systems, which has raised doubts about the viability of exclusive supplier networks across the country. Patients and officials had protested against the threat of interruption of care. A week later, a Commonwealth Court judge ruled in up support for UPMC that Shapiro could not change or extend the end date of an agreement between the two health systems negotiated by the state in 2014 in the name of the public interest. The new 10-year contract applies to the vast majority of patients.
It assures UPMC that Highmark patients are not calculated on plans that accept UPMC more than the market prices it calculates for similar Allegheny Health Network treatments. A week before thousands of people lost access to UPMC providers, Highmark Health and UPMC agreed on a 10-year agreement allowing Highmark Blue Cross and Blue Shield patients to continue to be treated at UPMC facilities in western Pennsylvania. What is the impact of the Highmark and UPMC agreement on Medicare Advantage? The 10-year contract allows UPMC and Highmark to reserve the right to develop additional plans that exclude the other, as long as each patient has access to at least one plan that includes access to both systems.