Restricting access to prestigious, long-available providers can sometimes cost insurers long-held contracts and be competitive gains for others.
In greater Pittsburgh, the North Allegheny School District is ending its health benefits contract with Highmark Blue Cross and switching to UnitedHealthcare for its 1,041 full time employees and dependents.
It's the biggest contract lost by Highmark in its ongoing network challenges with the University of Pittsburgh Medical Center. Many Highmark members set to lose in-network access to UPMC facilities at the end of the year, amid a lack of agree on pricing and Highmark's nurturing of its own Allegheny Health Network, UPMC's largest regional competitor.
"In light of the recent changes happening with healthcare in the Western Pennsylvania region involving UPMC and Highmark, North Allegheny School District is proud to announce that the School Board just approved UnitedHealthcare as our new insurance carrier effective January 1, 2015," the school district announced.
The change "is to ensure minimal disruption to the network of high-performing doctors and health facilities that you value," school administrators said in a letter to employees. "Without this transition to a national carrier, NASD staff would have experienced 60 percent disruption in care provided by local physicians and at nearby locations such as UPMC Passavant and Magee-Womens Hospital."
The deal is perhaps not as big a blow to Highmark as a contract with UPMC Health Plan would have been, and even amid concerns over access to UPMC, Highmark has retained key group contracts with employers, including Allegheny County's 15,000 public employees and their dependents.
But the deal does underscore just how key a dominant and academic health system can be to an insurer's networks. It's also a big win for UnitedHealthcare, which is making a marketing push across Pennsylvania and in particular greater Pittsburgh.
United has been in the midst of limited network disputes itself recently closed its own saga with Indiana University Health -- though with a slightly different outcome. After a stalemate over moderate cost-sharing increases for members using the 20-hospital IU Health, United renewed a contract to keep the in-network for about 400,000 members for at least the next two years.