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Upmc Highmark 10 Year Agreement

UPMC and Blue Cross Blue Shield System Highmark have been on the ground for years as the two Pittsburgh companies compete for market share in Pennsylvania, which is due to wider litigation between suppliers and payers. Shapiro, Jeffrey Romoff, CEO of UPMC, and David Holmberg, CEO of Highmark, have been negotiating since a Commonwealth Court judge ruled on June 14 that a five-year approval order guaranteeing Highmark patients` access to UPMC providers would end on June 30, as planned. The agreement does not cover patients in other parts of Pennsylvania. The boards of UPMC and Highmark signed the 10-year contract early Monday morning, leaders of both health systems said. The document, which has not been released, awaits final approval from the State Department of Insurance. A UPMC spokesperson said the problem had been resolved collaboratively, and UPMC “recognizes that we were able to reach this agreement with Highmark on a long-term network-based contract.” 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. Wolf said his administration and insurance supervisors had been working hard to come up with such a solution, “for many years, but it really took a concerted effort, the dedication of Josh (Shapiro) and his team to really bring them together.” Moreover, he said, contrary to the previous approval decree, it is an agreement between the two parties without state intervention. 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. Today`s news of a contract between Highmark and UPMC keeps alive the promise made to our community over the past five years at Highmark Health: consumers and patients have two excellent health systems to choose from for their care, in addition to our many independent community hospitals. 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. In 2012, UPMC objected to the renewal of its contract after Highmark purchased the existing Allegheny Health Network and became what UPMC considered a competitor in the provision of health and insurance coverage services.

This resulted in a five-year approval decree, which expires on Sunday.

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