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Patients First initiative delivers certainty for health care consumers in Western Pennsylvania

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SOURCE Highmark

New beginning in health care provides roadmap for assuring high-quality, affordable health care

PITTSBURGH, June 27, 2014 /PRNewswire/ -- Western Pennsylvania residents will have access to doctors and hospitals and new levels of protection against health care disruption under the terms of a new accord announced today by Gov. Tom Corbett in Harrisburg. Highmark Health fully supports the arrangement, formally two consent decrees, noting that it provides a "roadmap" for how Highmark members can access high-quality, affordable health care across Western Pennsylvania, including UPMC, Allegheny Health Network and a comprehensive network of community hospitals. Importantly, the new arrangement anticipates what's critical for patients, sets out a series of guidelines and delivers continuity of care and stability to the region's health care marketplace.

"Since the inception of Patients First, we have welcomed and supported the efforts of our leaders in Harrisburg," said David Holmberg, president and CEO of Highmark Health. "Today marks a new beginning in health care, and we want to thank the governor, attorney general, secretary of health and insurance commissioner for their commitment to the people of our region. We also thank the many legislators who have been working to protect patients' access to affordable care, in particular Senators Randy Vulakovich and Jay Costa and Representatives Jim Christiana and Dan Frankel. We've made significant progress in just a few short weeks in clearing up confusion, laying aside self-interests and working collaboratively to put in place safeguards for our patients and consumers."  

"While there are details yet to be resolved, the terms that we have reached offer a positive result for our members," said Deborah Rice-Johnson, president of Highmark Health Plan. "There are important safeguards related to cancer care and emergency room access. As to the concerns expressed about whether members will be able to keep their doctors, the answer for the vast majority is 'yes,' and in the instances where they won't, we will help facilitate the transition to high-quality, in-network doctors and hospitals.

"At the heart of this arrangement is continuity of care for a Highmark member in the midst of a course of treatment at UPMC, and the decree specifies that it shall be on an in-network basis with in-network rates."

With regard to specifics, Highmark members will have in-network access to many UPMC facilities and physicians, including, but not limited to, oncology services at the Hillman Cancer Center and all other UPMC owned or managed cancer facilities and physicians. The arrangement provides significant consumer protections and access related to all UPMC emergency departments. Highmark members who seek care at any UPMC emergency room will be covered at in-network rates. This care includes not only the emergency room visit, but also any inpatient admissions and continuity of care. Furthermore, the decree provides certainty with respect to access for Highmark's senior members, whether they have Medicare as their primary or secondary insurance, are enrolled in a Highmark Medicare Advantage program or have any other retiree program offered by Highmark.

With regard to hospitals, Highmark members will retain full access to all UPMC facilities outside of the five-county, Pittsburgh region, including UPMC Bedford, UPMC Venango, UPMC Hamot and its affiliate Kane Community Hospital, UPMC Altoona, UPMC Horizon and any facilities acquired by UPMC in the future. Western Psychiatric Institute and Clinic, UPMC Children's Hospital and UPMC Mercy will remain in-network.

Highmark expects that this decree will serve as a roadmap for how Highmark members will continue to access UPMC. It also provides the continued ability to develop such health insurance products and services as tiered networks and consumer-focused health plans, to meet the changing needs of customers. 

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