Feeling like a hostage

The city and its workers, like many other employers and employees in western Pennsylvania are caught in the fight between UPMC and Highmark BC/BS.

I can’t help but feel UPMC is holding us hostage.

As most already know, UPMC refused to negotiate a new agreement with Highmark, one of the region’s largest health insurance providers, after Highmark agreed to buy into the troubled West Penn Allegheny Health Systems. The Allegheny system was in danger of financially collapsing without finding a partner. If that were to happen, hospitals would likely have been shuttered and a lot of people left without services or health care providers. In addition, it would have given UPMC a near monopoly in the Pittsburgh metropolitan area.

UPMC announced that since Highmark would be a provider, not just an insurer, it could not do business with it. As a result, there would be no new contract when the current contract with Highmark expires on June 30, 2012.

Those with Highmark BC/BS insurance would be “out of system” and have to pay much higher fees for using a UPMC hospital and the many doctors and others who are either employed directly by or are contractually within the UPMC system.

I find it ironic that UPMC does not want to do business with Highmark because it would be both a provider and an insurer, when that is exactly how UPMC operates.

The UPMC propaganda machine has been working overtime on putting its spin on things. City council has received two very pointed letters from UPMC officials, and UPMC has really been on the front-end of the media push, at least in northwestern Pennsylvania.

In the latest letter, Gregory Peaslee, UPMC senior vice president, noted that UPMC is very concerned that the city’s employees continue to have access to UPMC physicians and hospitals.

I bet not has concerned as I am. City employees do not have a lot of choice. UPMC is the local hospital and most of the local doctors are in the UPMC system. Sure, someone could go to Titusville or Clarion, but the truth is UPMC has a local monopoly and has just moved to strengthen that.

Bear in mind, the city and its employees selected Highmark BC/BS over competing plans, including UPMC Health Plan, because it was the best value.

To make its position more palatable, or at least sound that way, UPMC has announced it has gotten four other insurers to come on board. There is some argument that that will result in more competition than has existed in the past in western Pennsylvania and therefore lower comparable costs going forward.

Still, I can’t help by view what UPMC is doing as a squeeze play and yet another attempt to assert its hegemony in the region.

Face it, UPMC has not exactly been a gentle giant when it comes to dealings with the remaining independent local hospitals in the region, such as Titusville or Clarion. If you doubt that, talk to the people in the know at those facilities.

The merger of our local hospital(s) into UPMC brought us a beautiful, new hospital. I’m not sure what other benefits have accrued.

Many “back office” jobs have been shipped off to Pittsburgh. It strikes me that a lot of people are now sent to UPMC’s Pittsburgh centers for procedures that use to occur locally and we have not gained the promised increase in specialists, and in fact have fewer of some than we did before.

And now UPMC is saying it won’t play ball with the city’s current health care insurance provider.

I’m sure Highmark BC/BS is no business saint – I’ve had my share of disputes with them – but UPMC is really something else.