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In Western Pennsylvania last summer and fall, a battle between the leading hospital service provider and the leading health care insurer threatened patient access to appropriate physicians and facilities. It is set to repeat itself in 2014, when the short-term extension ultimately agreed to by the parties ends.

The greater Pittsburgh health care market is highly concentrated with respect to both health insurance and health care services. If Highmark’s acquisition of West Penn Allegheny Health System is approved, there will be two integrated health care delivery systems in Pittsburgh. One (Highmark) has 60% plus of the health insurance market share, but even with the acquisition will have much less of the hospital services and physician services markets. The other, UPMC, has a 55 % market share in the hospital services market and a substantial number of employed physicians, but much less of the health care insurance market through its health insurance arm, UPMC Health Plan. How will the health care needs of patients be served with this double-lopsided market? What if both sides draw their lines in the sand and refuse to contract with physicians, practitioners and facilities that are not employed, owned or formally affiliated with one of them? Many patients will suffer needlessly. In addition, many private practitioners and facilities could be devastated if Pennsylvania legislators fail to ensure their ability to remain “in network” if they are qualified and willing to accept the terms of the contract.

The type of legislation that we are advocating is called “any willing provider” (AWP) legislation and has been in existence in other states since the 1990s and even before. The ability of physicians, other licensed health care practitioners and privately owned facilities--private providers such as ambulatory surgery centers, physical therapists and others--to contract with third party payers may be significantly eroded.

This website is designed to help you understand how AWP legislation could benefit private providers and patients alike.

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