Pittsburgh health care battle and how it may impact your practice.


The players are Highmark and UPMC.

Highmark is a not-for-profit healthcare company based in Pittsburgh. It is the largest health insurer in Pennsylvania, West Virginia and Delaware. It also has a presence in many other states through its subsidiary Highmark Blue Cross Blue Shield. Highmark represents 60% of the patients in the Pittsburgh region.

UPMC is the University Of Pittsburgh Medical Center that is the largest hospital system in Pittsburgh. According to Modern Healthcare it represents 60% of the Pittsburgh area medical and surgical business with many hospitals, outpatient clinics and physician offices that are owned by the organization. UPMC also operates its own health care plan under UPMC Insurance Services.

In 2013 Highmark acquired West Penn Allegheny the second largest health care system in Pittsburgh. The contract between Highmark and UPMC is expiring and UPMC may no longer be a provider in the Highmark network. Patients with Highmark may be limited to Highmark owned facilities. Providers with UPMC may find that their current patients are no longer covered for services at their facilities.

Other hospital systems are increasing in size and starting to offer their own Health Care Plans, or more heavily marketing existing plans. Insurance companies are acquiring hospitals and other health care facilities. The big players are moving to increase their market size and clout through acquisition and strategic partnerships.

The impact these battles between giants will have on individual providers is unknown. Individuals and employers could switch to a UPMC or other plan that provides them with access to the UPMC system, or they could elect to remain with Highmark and access the Highmark system, or even elect to go to a third insurance that gives them access to both systems. With so many moving parts it may be best for the small provider to maintain as many relationships as possible to be well positioned no matter how this battle shapes up, choose a side now and be purchased by a large health care system, or as some practices are doing opt out of all relationships and move to a concierge practice.

It is important for practices and practice managers to stay abreast of the moving parts that are in their market so that they can best position their practice for whatever comes next.