Highmark-UPMC skirmish opened doors in Pittsburgh's private Medicare market

While Pittsburgh-based rivals Highmark and UPMC battled over their contract, national payers creeped into the region's private Medicare market that the dueling institutions previously dominated, according to the Pittsburgh Post-Gazette.

In 2014, Highmark and UPMC had a combined Medicare Advantage membership of 115,278 members. At the time, other insurers didn't have a tenth of that total, according to the report.

But as Highmark and UPMC fought over their relationship in the following five years — a dispute that ultimately culminated in a 10-year agreement — national health insurers like Aetna and UnitedHealthcare picked up market share. Aetna, buoyed by its purchase of HealthAmerica, now has 36,475 members in the region's private Medicare market. That's up from 7,334 in 2014. UnitedHealthcare now as a membership of 11,166, compared to only 751 in 2014. In the five years of uncertainty, national payers like Aetna and UnitedHealthcare offered beneficiaries what UPMC and Highmark couldn't: in-network access to both UPMC and Highmark.

Still, UPMC and Highmark lead the pack in Medicare Advantage membership. UPMC has 62,574 Medicare Advantage members, while Highmark has 39,886.

Read the full article here.

More articles on payers:
CMS delays start of primary care payment model
CEO of Texas Health Aetna out after 8 months
UnitedHealth drops appeal of Supreme Court decision on alleged overpayments

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