Highmark cuts ties to urgent care center

UPMC affiliation makes it toxic amid insurance wars
March 7, 2012 1:05 am

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Citing the ongoing contract impasse with UPMC, Highmark has terminated its contract with a Washington Hospital-affiliated urgent care center, which means treatment there is now considered "out of network" for Highmark subscribers.

The move to exclude the urgent care center, combined with Highmark's announcement Feb. 21 that it would not include UPMC East Hospital in its network when the hospital opens in July, may signal a change in strategy for the region's largest insurer, says a local health care consultant.

"They are starting to be forced to play hardball," said Jan Jennings, president and CEO of American Healthcare Solutions, Downtown.

"Highmark is fighting for its life. UPMC has a stranglehold on hospital care in Western Pennsylvania and, without a contract with UPMC, many of their subscribers are going to drift off to other insurance companies."

He added: "Until UPMC and Highmark come to some sort of resolution, you're going to see World War III tactics going on with both parties. It's going to get ruthless."

Since Dec. 1, UPMC and The Washington Hospital have jointly operated the urgent care center located in the Krebs Professional Center on Washington Road in McMurray. The two have announced plans to open and operate two additional sites in the next 18 months.

The center was part of Highmark's network prior to Dec. 1, when it was run by a firm called Health Futures. Health Futures' incorporating papers list Washington Hospital President and CEO Gary B. Weinstein as its president.

Highmark ended the contract after it learned that UPMC affiliated with the center, which is now called, "UPMC Urgent Care with The Washington Hospital."

UPMC and Highmark remain at loggerheads about renewing their current 10-year contract, the terms of which run through June 2013.

UPMC officials say they will not negotiate a new contract now that Highmark intends to purchase the West Penn Allegheny Health System and compete in the health provider market. Highmark officials, for their part, say they are acquiring the financially ailing West Penn Allegheny system to preserve provider choice in the Pittsburgh market.

Noting that the urgent care center has been operating for four years, UPMC spokesman Paul Wood said Tuesday, "The denial of access and services to local communities, just like their similar refusal of a Medicare contract at UPMC East, is exactly the kind of behavior we can expect to see in the future from Highmark.


First Published 2012-03-06 23:11:03

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