Judge: UPMC Must Provide In-Network Access To Highmark Medicare Members

DSC01842More than 180,000 seniors who rely on Highmark Inc. for Medicare Advantage will keep in-network access to UPMC at least until 2019, Commonwealth Court President Judge Dan Pellegrini ordered Friday.

His three-page decision commands the Downtown-based rivals into binding arbitration to resolve other disagreements they cannot settle on their own — a move that delighted Gov. Tom Wolf and Attorney General Kathleen Kane.

UPMC vowed to appeal to the state Supreme Court.

“The feud between these two companies must end — the people of Western Pennsylvania have had enough,” Wolf said in a statement.

Read more: http://triblive.com/news/adminpage/8465390-74/upmc-access-network#ixzz3bd7KLBrW
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UPMC Offering Buyouts To 3,500 Employees In Cost-Cutting Move

DSC01840UPMC is offering buyouts to 3,500 of its older workers in a move to cut costs as the Pittsburgh hospital giant adjusts to slowing demand for hospital-based care.

The nonprofit organization said Tuesday that it was offering the voluntary severance to employees who are 60 or older and have at least 10 years of service. The offer, which was made to 5.6 percent of UPMC’s total workforce, includes medical and dental benefits, severance pay and a one-time cash payment of $15,000, UPMC said in a statement.

“This program both honors and respects long-term staff members who are ready to move to the next phase in life and, simultaneously, helps achieve cost-savings for UPMC by adjusting our workforce to meet the demands of the health care marketplace,” the statement said.

UPMC is the state’s largest private employer, with about 62,000 workers.

Read more: http://triblive.com/business/headlines/8442119-74/upmc-health-largest#ixzz3bM0tSWNm
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Allegheny Health Network’s $600M Plan To Expand Reach Depends On Highmark

Allegheny Health Network proposes investing part of $175 million from Highmark Inc. in renovations and technology upgrades at its Allegheny General and West Penn hospitals, anticipating that they will accommodate more patients when Highmark insurance subscribers lose in-network access to UPMC next year.

The Highmark-owned hospital system would build outpatient medical centers and expand emergency, trauma and women’s health services to underserved parts of Western Pennsylvania as part of a spending plan that executives say will help it better compete with UPMC.

“The entire amount … will be used for capital improvements at Allegheny Health Network to fill in certain service line gaps,” Chief Financial Officer Karen Hanlon said during a state Department of Insurance hearing Monday. “No portion of the requested funding will go to pay operating expenses.”

UPMC Treasurer Tal Heppenstall Jr. said Allegheny Health Network is in worse financial condition than Highmark has reported and chided the company for its “profound lack of financial transparency.” He said it appears Highmark is hiding huge losses in “sporadic, fragmented and murky” financial statements.

Read more: http://triblive.com/news/healthnews/8208546-74/highmark-health-network#ixzz3ZH4hmeqt
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Blue Cross Affordable Care Act Rates To Rise

Members enrolled in Blue Cross of Northeastern Pennsylvania’s Affordable Care Act plans will see their premium rates rise by an average of 6.9 percent in 2015.

Officials for the Wilkes-Barre-based insurer declined to specify how many members are covered by its Affordable Care Act plans. Its website shows 12 available 2014 “Blue (Affordable Care Act) Metal” plans.

“The increases are necessary to meet the coverage requirements, including essential health benefits, of the (Affordable Care Act) and to keep up with the cost of care for members in our ACA products,” said Anthony Matrisciano, spokesman for Blue Cross of NEPA, which has about 550,000 members across 13 counties.

The increase, effective Jan. 1, comes amid a state Insurance Department review of Highmark Inc.’s proposal to acquire Blue Cross of NEPA. It’s one of two rate hikes submitted by the insurer that received approval from the state Insurance Department.

Read more: http://citizensvoice.com/news/blue-cross-affordable-care-act-rates-to-rise-1.1789100

Some At Altoona Regional Health System Urging Caution In UPMC’s Acquisition

Map of Pennsylvania highlighting Blair County

Map of Pennsylvania highlighting Blair County (Photo credit: Wikipedia)

UPMC‘s months-in-the-making acquisition of the Altoona Regional Health System may soon be finalized, but the deal is not sitting well with some employees and community residents.

Last week, a petition with some 2,000 signatures was delivered to Altoona Health officials, urging them “to slow down and stop exclusive talks with UPMC in order to re-examine the best future course for our hospital.”

The next day, Altoona president and CEO Jerry Murray sent a letter to the health system’s 6,000 employees that said the UPMC affiliation was on track for a July 1 completion announcement, pending final approval from the board and the state attorney general’s office.

“There are some very well-meaning people in the community who have concerns, and we appreciate the concerns that they have.  Unfortunately, there are also some with self-serving motives,” said Dave Cuzzolina, Altoona Health’s director of marketing and communications.

Read more: http://www.post-gazette.com/stories/business/news/some-at-altoona-regional-health-system-urging-caution-in-upmcs-acquisition-692480/#ixzz2WrrppOnu

Saint Vincent Reaches Final Agreement With Highmark

Headquarters of the insurance company in Pitts...

Headquarters of the insurance company in Pittsburgh, , . Address 120 Fifth Ave., Downtown. (Photo credit: Wikipedia)

Editor’s note:  Those folks at Highmark are gobbling up anything that’s not nailed down!

Erie, PA – The future of Saint Vincent Health System is now in the hands of Erie County Orphans’ Court.

Saint Vincent and Highmark Inc. have reached a definitive agreement for the Erie hospital to join Highmark’s integrated delivery system — the newly named Allegheny Health Network.

Saint Vincent would join Jefferson Regional Medical Center and West Penn Allegheny Health System in the network.  The Pennsylvania Insurance Department announced its approval Monday of Highmark’s takeover of West Penn.

“We look forward to joining the Highmark (network) in the very near future, along with Jefferson Regional Medical Center and West Penn Allegheny Health System, as we work to preserve health-care choice and ensure access to the highest level of quality care for residents throughout all of western Pennsylvania,” Saint Vincent Chief Executive Scott Whalen said in a statement.

Read more:

http://goerie.com/article/20130430/NEWS02/304309961/Saint-Vincent-reaches-final-agreement-with-Highmark

Pennsylvania Approves Highmark-West Penn Allegheny Health System Merger

Headquarters of the insurance company in Pitts...

Headquarters of the insurance company in Pittsburgh, , . Address 120 Fifth Ave., Downtown. (Photo credit: Wikipedia)

The Pennsylvania Insurance Department today gave conditional approval for insurer Highmark Inc. to affiliate with the financially ailing West Penn Allegheny Health System, laying the foundation for Highmark’s plans to establish an integrated health care delivery system to compete with UPMC.

Insurance commissioner Michael Consedine, in a release announcing the decision, said, “Our goal from the outset was to have a comprehensive, transparent review in order to make a fully informed and well-founded determination.  We have met that goal.”

In statement, Gov. Tom Corbett said “the goals for the commonwealth are to improve health care access, quality and affordability.  Today’s decision is an important step toward making these goals a reality in Western Pennsylvania.”

Read more: http://www.post-gazette.com/stories/business/news/state-approves-highmark-west-penn-allegheny-health-system-merger-685517/#ixzz2RreWfl90

Highmark CEO Compensation Tops $6M

English: Highmark Place from PNC Park in Pitts...

English: Highmark Place from PNC Park in Pittsburgh, taken 2008 showing the new Highmark branding atop. (Photo credit: Wikipedia)

Last year, Highmark Inc. dished out more than $6 million to compensate its three CEOs.

In compensation figures filed with the state Department of Insurance this month, the state’s largest insurance company said it paid former CEO Kenneth Melani $3.3 million in 2012, even though he was fired April 1.  He was the highest-paid company employee for the year.

In fact, three of Highmark’s 10 highest-paid employees in 2012 are no longer with the company, having left early in the year.  In addition to Dr. Melani, former Highmark legal officer and corporate secretary Maureen Hogel and retired auditor and compliance officer Elizabeth A. Farbacher also had left Highmark by April.

Current Highmark CEO William Winkenwerder Jr., who was hired over the spring and began work July 16, took home $1.87 million in total compensation — $562,712 for his half-year of salary, plus a $1.18 million bonus and $131,000 in “other” compensation.

Read more: http://www.post-gazette.com/stories/business/news/highmark-ceo-compensation-tops-6m-679520/#ixzz2NiolPvSN

Geisinger Tops UPMC In Pennsylvania Member Satisfaction, J.D. Power Reports

Geisinger Health Plan was tops in member satisfaction among Pennsylvania health plans with UPMC Health Plan and Central Pennsylvania’s Highmark Blue Shield not far behind, according to a report released today by J.D. Power and Associates.

Geisinger finished with 739 points out of a possible 1,000 to claim highest member satisfaction for the second year in a row.

Read more: http://www.post-gazette.com/stories/business/news/geisinger-tops-upmc-in-pennsylvania-member-satisfaction-jd-power-reports-678839/#ixzz2NFD01q76

West Penn Allegheny Cancels Highmark Affiliation Agreement

English: Highmark Place from PNC Park in Pitts...

English: Highmark Place from PNC Park in Pittsburgh, taken 2008 showing the new Highmark branding atop. (Photo credit: Wikipedia)

Saying that Highmark Inc. wanted it to restructure through bankruptcy, West Penn Allegheny Health System canceled the $475 million deal under which the insurer planned to acquire WPAHS.

WPAHS board chairman Jack Isherwood said in a written statement this morning that he considers bankruptcy a poor option for the health system’s employees and customers.

“To us, bankruptcy is not the first option, it’s the last option,” he said.

WPAHS is actively looking for new partners and is willing to consider all types of companies — another insurer, nonprofit, for-profit.

Senior management will remain in place, Mr. Isherwood said.

Highmark Fires CEO After Extramarital Scandal Revealed

Highmark Place from PNC Park in Pittsburgh, ta...

Highmark Place from PNC Park in Pittsburgh, taken 2008 showing the new Highmark branding atop. (Photo credit: Wikipedia)

Highmark today fired president and CEO Kenneth R. Melani in the wake of a scandal involving an extramarital affair and allegations that he assaulted the husband of his mistress.

The insurance giant’s board of directors announced the firing after a meeting this morning, in a statement that said his termination was “for cause.”

“The board has reviewed this situation thoroughly and has taken decisive action to address the matter,” said board chairman and acting CEO J. Robert Baum.

“For 75 years, Highmark has served this community with integrity and is committed to maintaining the highest standards. We have dedicated, hard-working employees and I know they take great pride in working for Highmark. Our mission of providing quality, affordable health care has never been more important, and I’m looking forward to working with our employees and senior management team in addressing the many challenges and opportunities that lie ahead,” he said.

Read more: http://www.post-gazette.com/stories/local/neighborhoods-city/highmark-fires-ceo-melani-629445/

Failed Democratic Candidate For Governor Of Pennsylvania Dan Onorato Finds Life After Politics

Headquarters of the insurance company in Pitts...

Image via Wikipedia

Dan Onorato may have lost the Pennsylvania Governor’s race to Tom Corbett, but when his job ends as Allegheny County Executive he will start a new job in the private sector.

Allegheny County Executive Dan Onorato will join health-insurance giant Highmark Inc. as one of its top executives when he leaves office next month.

His multi-part title will be executive vice president, chief external affairs and communications officer.  He will begin his new job Jan. 3, the day Rich Fitzgerald will succeed him as county executive.

Mr. Onorato will report to Ken Melani, Highmark’s president and chief executive officer.

The appointment was announced Friday.

Read more: http://www.post-gazette.com/pg/11351/1197577-455.stm#ixzz1gr67xpvh