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Commonwealth Inks Deal With UPMC Health Plan

August 29, 2018

UPMC Health Plan will offer in-network coverage for Commonwealth Health patients, the regional health system announced Tuesday.

The agreement between the Pittsburgh-based insurance provider and the health system means UPMC Health Plan members will pay in-network rates for care at Commonwealth facilities and providers.

The Pittsburgh-based company is owned by UPMC, the $19 billion health system affiliated with the University of Pittsburgh.

The deal introduces a new major player in an already competitive health care market, one that’s dominated by two major systems — Commonwealth, a subsidiary of the for-profit Community Health Systems based in Tennessee, and nonprofit Geisinger Health System, which is headquartered in Danville.

UPMC has made smaller inroads to the region with its Community Care Behavioral Health Organization, an insurance company that helps people with Medicaid get mental health services. Community Care has an office in Moosic.

The hospital system’s closest facilities, UPMC Susquehanna, are in Williamsport.

“UPMC Health Plan is making a concerted effort to grow membership in the northeastern Pennsylvania counties through strategic partnerships and a suite of high-quality affordable coverage options, and we intend to continue this growth,” spokeswoman Gina Pferdehirt said in an email.

A little fuel on the flames of rivalry likely means good things for consumers, said Daniel West, Ph.D., health administration and human resources professor at the University of Scranton.

“UPMC is trying to establish itself in our medical trade area,” he said, adding that such a move, into a strong market with room for more insurers, should be expected from companies eyeing expansion.

The new health plan’s arrival should help stabilize, if not improve, pricing, he said. New insurance products will give employers more selection and possibly better prices when shopping for group plans for their workers.

“I don’t see any drawbacks,” he said. “I’m sure competitor insurance plans would see it as a problem, but looking at it from a consumer standpoint, I think it makes good sense.”

The health plan boasts more than 3.4 million members across its service area. It was unclear Tuesday how many of them live in the northeast now.

The contract includes six Commonwealth hospitals: Moses Taylor Hospital and Regional Hospital of Scranton in Scranton, Wilkes-Barre General Hospital, Tyler Memorial Hospital in Tunkhannock, First Hospital in Kingston and Berwick Hospital Center.

It also includes affiliated physician groups within the Commonwealth Health Physician Network including InterMountain Medical Group, Physicians Health Alliance, Berwick Medical Professionals and Great Valley Cardiology.

The agreement applies to patients who have UPMC commercial and Medicaid insurance plans.

“We strive to work with all insurers in our market to provide access and choice to the people of our community,” Commonwealth Chief Executive Officer Cor Catena said in a statement. “Adding UPMC Health Plan to our network helps us to continue that mission.”

Contact the writer:

joconnell@timesshamrock.com; 570-348-9131; @jon_oc

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