UPMC Health Plan forms venture with Reading Health

Provider-owned insurer UPMC Health Plan and Reading Health System are forming a joint venture to offer health insurance to employers and individuals in southeastern Pennsylvania.

Pittsburgh-based UPMC Heath Plan and West Reading, Pa.-based Reading Health will introduce a range of insurance options throughout 2017, including Medicare Advantage, Medicaid, individual, fully insured and selfinsured group, special needs and children’s health insurance plans. UPMC Health Plan will begin offering Medicare Advantage in the area with the open enrollment period that wraps up Dec. 7 and has offered Medicaid there for the past couple of years.

Starting Jan. 1, UPMC Health Plan will also provide third-party administrator and flexible-spending account administration services for Reading Health’s employee benefit plan serving 11,000 beneficiaries.

Reading Health is “acutely aware of what their community needs are,” said Sandy McAnallen, UPMC Health Plan’s senior vice president of clinical affairs and quality. “What we do together as a payer-provider is we develop benefit plans and clinical strategies that we’ll do collectively to meet the needs of the community.”

The venture is among the latest insurer-provider partnerships formed this year by health plans and systems grappling with how to lower costs and improve the outcomes of the patients they serve. Hartford, Conn.-based Aetna, for example, launched a venture with Texas Health Resources in May, and Indianapolis-based Anthem struck a partnership with Aurora Health Care in Milwaukee in April.

In such partnerships, health plans typically offer incentives to drive patients to the health system’s narrow network of providers with the promise of higher quality and lower costs. Patients who choose to seek care outside of the network pay most or all of the cost of care out of pocket.