Highmark membership suffers as patients seek plans with full UPMC access

Although the battle has gone back and forth between Highmark and Pittsburgh-based UPMC, it was health insurer Aetna that came out of the fight on top, according to a TribLive report.

The contract dispute between Highmark and UPMC allowed Aetna and other insurers that provide in-network access to UPMC to take over some of Highmark's market share in western part of Pennsylvania. As of January, Highmark had a 60 percent market share in Western Pennsylvania, a 29-county region, down from a 63 percent market share in January 2014.

The decrease in the insurer's market share was driven by a loss of 150,000 employer-group members "who were concerned about keeping discounted access to the UPMC's huge network of 20 hospitals and more than 3,500 physicians," according to the report.

On the other end of the spectrum, Aetna added approximately 150,000 members in Western Pennsylvania in the last year. That number includes new employer groups, individual policies and Medicare Advantage plans, a spokesperson for Aetna, Walt Cherniak, told TribLive. "The overwhelming majority of that new membership came from Highmark," Mr. Cherniak said.

Highmark is not discouraged by its membership numbers. Tony Benevento, senior vice president of Highmark's insurance business in Pennsylvania, told TribLive the health insurer "retained 87 percent of its commercial customers even though it faced unprecedented competition."

More articles on payer issues:

Christ Hospital terminates contract with Horizon BCBS of New Jersey
Health insurer Centene's profit more than doubles
Anthem's profit increases on higher enrollment

Copyright © 2023 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Top 40 articles from the past 6 months