Lines drawn for next Highmark-UPMC tiff

What’s “fair and affordable?” Well, of course, it depends on who’s talking.

But “fair and affordable” and “reasonable” are words getting a lot of play these days by the unlikely couple of Highmark Inc. and the Service Employees International Union as Blair County becomes the third county to have only one big hospital, which is run by UPMC. The others are Venango and Bedford counties.

These counties may well form the next front in the UPMC-Highmark struggle, but we get ahead of ourselves. Let’s back up.

Altoona Regional Health System directors last month agreed to accept $250 million over 10 years from UPMC for capital improvements, plus $10 million for its charitable foundation. In return, the hospital is now called UPMC Altoona.

So, here’s the hitch: Highmark has some 45,000 members in Blair County and the company’s contract with UPMC expires Dec. 31, 2014. UPMC said it wants a contract with Highmark and every other insurer, and Highmark and the SEIU have been plugging for a “fair and affordable” or “reasonable cost” provider contract with UPMC.

Hold on, there’s a twist.

“Residents across western Pennsylvania, including the Altoona region, have been loud and clear that they want UPMC and Highmark Health Services to collaborate and we will continue to strive for a multiyear agreement with UPMC to ensure that our members continue to have in-network access at a reasonable cost to all UPMC hospitals and doctors,” Highmark said in a statement.

So, Highmark wants to sew up all UPMC doctors and hospitals for Highmark members as part of a bigger agreement, something UPMC and its board have said firmly will not happen.

“UPMC will continue to offer Highmark subscribers in-network access to those hospitals outside southwestern Pennsylvania that are the only health care option in their region, such as UPMC Northwest, UPMC Bedford Memorial and UPMC Altoona,” UPMC wrote in a statement. “UPMC welcomes negotiations and expects to reach agreements with all insurers in the Altoona market, including Highmark.”

Now it’s up to the two sides to work out what’s “reasonable.”

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