Standing Our Ground

By: Paul Wood

The Attorney General earlier today alleged that both UPMC and Highmark violated the Consent Decree.  A careful review clearly demonstrates that there is no basis – legal or otherwise — for any of the Commonwealth’s misinformed claims against UPMC.

We also cannot agree that arbitration would solve the issues that divide Highmark and UPMC.  The Consent Decree required Highmark to arbitrate, on an expedited basis, its assertion that it can change the rates it is obligated to pay UPMC unilaterally.  Highmark then actively subverted and ultimately halted the mandated arbitration with litigation that the Commonwealth maintains “undermines” protections for seniors.

UPMC filed formal complaints with the Commonwealth twice last fall stating Highmark’s unilateral violation  would force UPMC to terminate the Medicare Advantage agreements for 2016.  These warnings were ignored by the Commonwealth, and it missed the opportunity to enforce the arbitration clause and get this issue resolved by the Consent Decree’s December 31, 2014 deadline. The April 1, 2015 deadline for Medicare Advantage contracting renewals also slipped by without action from the Commonwealth.

The termination of UPMC Medicare Advantage agreements with Highmark will not harm seniors.  They can expect to enjoy the benefits of more choice and competition and, likely, lower insurance premiums if they choose to stay in a Medicare Advantage plan.  Seniors always have the option of opting out of Medicare Advantage and, instead, can enroll in “traditional” Medicare fee-for-service.