State tells UPMC to keep its net­work open to High­mark, other plans

Modern Healthcare - - Late News -

Penn­syl­va­nia’s at­tor­ney gen­eral picked a side in the long-run­ning mar­ket bat­tle be­tween UPMC and High­mark Health, fil­ing a court petition Feb. 7 seek­ing to re­quire UPMC to ne­go­ti­ate fairly with High­mark and other health plans.

Demo­cratic At­tor­ney Gen­eral Josh Shapiro ar­gued that the UPMC health sys­tem has vi­o­lated its char­i­ta­ble obli­ga­tions to the state, and he wants the Com­mon­wealth Court to en­able open and af­ford­able ac­cess to UPMC’s provider net­work through ne­go­ti­ated con­tracts; re­quire base­ball-style ar­bi­tra­tion if ne­go­ti­a­tions fail; and bar UPMC from en­gag­ing in ex­ces­sive and un­rea­son­able billing prac­tices.

UPMC and High­mark signed a con­sent de­cree in 2014 gov­ern­ing their re­la­tions, and that ex­pires June 30.

Cit­ing the neg­a­tive ef­fects the mar­ket bat­tle be­tween UPMC and High­mark is hav­ing on Penn­syl­va­nia res­i­dents, Shapiro said the changes he’s re­quest­ing are “nec­es­sary to pre­vent UPMC from in­flict­ing fur­ther harm on the pub­lic by for­sak­ing its char­i­ta­ble obli­ga­tions in pur­suit of com­mer­cial suc­cess.”

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