Unhappy end

Highmark, UPMC split needlessly disrupts care

Highmark says it’s prepared patients for the coming split with UPMC, and a UPMC spokesman says the market “has pretty much adapted” to the new health care landscape.

But that doesn’t forgive the rivals’ failure to get along or the ugly fight for market share that has forced so many patients to change doctors, hospitals and insurers. Organizations in the health care field should be about facilitating continuity of patient care, not disrupting it.

The Highmark-UPMC divorce, delayed for several years at the behest of state officials, is set to occur next summer. Highmark has the Allegheny Health Network of facilities and providers, while UPMC has its own insurance programs, facilities and providers.

On its website, UPMC says, “Did you know that on June 30, 2019, the consent decrees between UPMC and Highmark will end? What does this mean? Most adult care provided by UPMC hospitals and doctors in the Pittsburgh and Erie areas will be out-of-network for Highmark and other Blue Cross Blue Shield members.”

In other words, Highmark customers will have to switch providers or insurers if they haven’t already or pay higher, out-of-network rates for care they’ve been accustomed to receiving at UPMC. There are some exceptions. Highmark customers still will have innetwork access to UPMC Children’s Hospital of Pittsburgh through June 2022, for example, and to Western Psychiatric Institute and Clinic of UPMC through June 2024.

UPMC suggests that the change will yield more competition and lower prices. While this may be true — someone should run the numbers in a few years — it does not obviate the inconvenience to patients. Not in Pittsburgh, a center of innovation where hospitals should be finding ways to work across organizational lines to deliver the best care anywhere. Not in a city where health care is an economic engine and growth industry. Not when local governments forgo untold real estate taxes because of the hospitals’ nonprofit status.

There is something upside down about a health care system that puts resources just out of reach of the people who need or want them. Think of the Highmark customer who believes that UPMC Magee-Womens Hospital is the best place to deliver her baby, the cancer patient who desires care at UPMC Hillman Cancer Center or the patient with a chronic condition loath to change specialists.

Perhaps, as UPMC says, competition will go up and prices down. But it’s also possible that quality of care will suffer because patients, failing to switch providers or insurers by the deadline, will skip a checkup or procedure. Perhaps some patients will have trouble finding new doctors or face longer wait times for appointments.

It’s facile to say people are adapting to the Highmark-UPMC split. The breakup is playing out in millions of lives in often immeasurable ways. In failing to co-exist in a competitive health care environment, Highmark and UPMC have violated a principal tenet of medicine: Do no harm.