Skip to Navigation
University of Pittsburgh
Print This Page Print this pages

September 28, 2000


Many helped to resolve health plan problem

To the editor:

Having read Professor Nathan Hershey's column in the Sept. 14, 2000, issue of the University Times, I thought it might be useful if I expanded upon his statement of the record. My concern is that members of the faculty and staff less familiar with our health insurance arrangements might be left with the wrong impressions of the roles that various departments and individuals play.

Let me first offer the reminder that it was with the formal support of the Faculty and Staff Medical Advisory Committee that the senior administration, after lengthy discussions, decided that a sole source arrangement should be entered into with UPMC Health Plan for the University's health insurance program. The Medical Advisory Committee (upon which Professor Hershey serves), as well as the senior administration, were keenly aware that many Highmark physicians very likely would not be included in the UPMC Health Plan's network of doctors. This issue was, in fact, discussed by the Medical Advisory Committee during the course of its deliberations.

In early March 2000, it was announced to faculty and staff that the University was entering into this agreement with UPMC Health Plan, effective July 1, 2000. Details concerning the plan, including timely notification that those physicians who were employees of Highmark would be excluded, were provided. However, the staff members from the Office of Human Resources also continued working to see if there might not be ways to expand the physician pool.

The major impediment to progress, from our perspective, was Highmark's reluctance to permit physicians in its practice groups to continue seeing patients who would now be covered by the UPMC Health System's plan. The University, then, had a clear interest as these two large insurance companies began setting a course for how they would work together in the future. However, the issue had implications far beyond Pitt and affected large numbers of patients covered under the health insurance policies of other employers.

As the summer progressed, Professor Hershey played a role in negotiations, relying upon his professional relationship with a former colleague who now is an executive with Highmark. As Professor Hershey noted, Chancellor Nordenberg also became involved, meeting directly with the president of UPMC Health System, who was very supportive of the University. The Office of Human Resources also was in constant contact with both insurance companies. The matter was successfully resolved earlier this month, and information concerning this change in the plan was sent to the respective participants late last week.

As is always true in matters of this type, the responsibility for representing the interests of the University rests in the Office of Human Resources, which reports to me. I assume that Professor Hershey's decision to contact Senior Vice Chancellor Levine was based on the belief that the close connections between our Health Sciences leadership and the UPMC Health System provided an advantageous opportunity to pursue this matter, and in making that assumption, he was correct. In fact, both Dr. Levine and Dr. Loren Roth played constructive roles in securing the positive resolution of this matter, as did Professor Hershey himself. However, as I noted above, the office responsible for handling these matters is the Office of Human Resources, not the Office of the Senior Vice Chancellor for the Health Sciences.

As I look back on this successful effort, which apparently will provide a range of coverage for members of our community that will not be available to other employers, I want to express my appreciation to Professor Hershey, to Dr. Levine, to Dr. Roth and to everyone else who participated in the process. People within the University and within UPMC Health System are working hard to make this new relationship work. This includes, in particular, the professionals in the Office of Human Resources. Particularly given the generally turbulent times in health care, I think we are off to a good start.

Jerome Cochran

Executive Vice Chancellor


Bragging about, then barring UPMC doctor

To the editor:

I was delighted to read in the Aug. 31, 2000, University Times that my primary care physician, Bernard Grumet, had been listed in Town & Country magazine as one of the 578 top PCPs in the nation — one of seven UPMC PCPs to be so honored. More accurately, I should refer to him as my former PCP because UPMC will neither permit him to be listed in the UPMC director nor to participate in the UPMC plan as a "network provider."

Unfortunately, Dr. Grumet (along with other physicians) is caught in a struggle between Highmark and UPMC. In my efforts to obtain information about a potential resolution to this battle, I was reminded of two clowns squirting seltzer at each other, with each side torturing both truth and language in an effort to blame the other. Both physicians and patients, consequently, are severely disadvantaged by the inability of both parties to resolve the problem in a responsible fashion, with patients deprived of quality medical care from doctors with whom they have established long-standing relationships.

I do not hold UPMC entirely responsible for the snafu. Further, I am encouraged by the newest information (University Times, Sept. 14) regarding a potential resolution to this problem (though I will remain skeptical until I see the details of the plan). Nonetheless, I am absolutely amazed that UPMC would shamelessly hold bragging rights to Dr. Grumet while, simultaneously, barring him from participation in the network.

Jon Hurwitz

Professor, Political Science


To the editor:

I am writing to first express my gratitude to Nathan Hershey, University Senate president, for single-handedly taking on the two giant health insurers in this area, UPMC Health Plan and Highmark. He successfully negotiated a settlement that is beneficial to 1,000-1,400 University employees and their dependents insured by UPMC Health Plan as of July 1, 2000, who could not keep their Highmark primary care physicians. The result of his dogged determination is that continuity of care is now in place.

Also, I appreciate the effort extended by the chancellor and by James Klingensmith, Highmark's vice president (and an alumnus of Pitt's Graduate School of Public Health) in working toward resolution of this conflict. Although I was granted a temporary transition of care from UPMC Health Plan's chief medical officer for my seriously ill husband through June 30, 2001, a transaction I coordinated, I am acutely aware that this transaction keeps the decision-making in the hands of UPMC Health Plan. It was an unsettling experience.

Also, I share Professor Hershey's concern regarding the question of a conflict of interest when an associate senior vice chancellor at the University of Pittsburgh also holds an administrative post with UPMC. Essentially whose side did he represent? I am glad that Professor Hershey will address his concerns about the potential conflict of interest later this year.

Again, I want to say thank you to the major players for a job well done.

Janet T. Bonk


Graduate School of Public Health

Leave a Reply