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March 16, 2000


Highmark left Pitt no choice, committee member says

To the editor:

I know that many members of the faculty and staff are unhappy about the move by the University to accept UPMC as its exclusive health insurance carrier. I am as well. However, as a member of the faculty and staff medical advisory committee for health benefits, I had no choice but to endorse this decision. High-mark, who has been my health insurance carrier for the past 35 years, made no significant effort to retain their share of the University's medical insurance.

The chancellor's letter describes the events leading to the choice of UPMC very accurately. However, it cannot begin to express the negative image that Highmark displayed during this process. Highmark's presentation lacked enthusiasm and emphasized unique characteristics of their company in which there was little interest. The committee was able to see beyond Highmark's poor preparation. Most distressing was the message that came through clearly — they were not interested in competing.

Highmark has apparently determined that they must make a significant profit on every contract. This, combined with their high overhead and growing costs caused by over managing managed care, makes them non-competitive. Rather than work to reduce their operating costs, they offered restrictive clauses that would have rates increase if they did not get an impossibly large percentage of the business. Over and over again, they were asked to reconsider their bid, but the only response was, in popular terminology, "This is our final answer." It would have been unconscionable for members of the committee to support the significantly larger cost as well as the hubris of Highmark. The members of the medical advisory committee were always in attendance, involved and dedicated. They asked the tough questions and, in the end, came to the same conclusion — to support the UPMC proposal.

I am going to miss having Blue Cross/Blue Shield. For those of us in the Comprehensive plan, it was easy to use when you were away from home. Everyone recognizes the BC/BS card. UPMC promises comparable service. We shall see. Remember that if the UPMC exclusive doesn't work, there will be plenty of health insurers willing to step in at a much higher cost.

Harvey Wolfe

William Kepler Whiteford



Chairman, Department of Industrial Engineering

School of Engineering


Elimination of Highmark as choice poses real problems

To the editor:

Once again those in power, operating in secrecy, making decisions for us all, have their way, and those of us who must abide by this decision may suffer. Mr. Frisch [associate vice chancellor for Human Resources] says he doesn't think there are many of us who will be unable to see doctors they now have. I find that hard to believe. I would suggest that Mr. Frisch, if he knows the numbers or not, just simply doesn't care how this will affect the staff. In fact among those with whom I have talked about this, the majority will have to find some, if not all, new doctors, thanks to our no longer having any choice in our health insurance.

In my own case, a gynecological group I have been seeing for 35 years is now off limits to me, the highly recommended office that does my mammograms is not on the list and the hospital of my choice, St. Francis, also will be unavailable. These were the facts that kept me from choosing the UPMC Health Plan last year. Are we to believe staff members such as myself are in a minority? I don't think so.

Way to go, folks. Keep the pay and benefits low. No wonder we can't keep staff.

Sharon A. Boag

Central Animal Facility


Ronald W. Frisch, associate vice chancellor, Human Resources, replies:

I am happy to respond to the letters from Dr. Harvey Wolfe and Ms. Sharon Boag concerning the University's decision to contract exclusively with the UPMC Health Plan for medical insurance.

First, I want to thank Dr. Wolfe for taking the time to express his thoughts and for so succinctly stating the obstacles faced by the medical advisory committee in the negotiations with Highmark Blue Cross/ Blue Shield. The indifference of Highmark during the negotiations led the committee to recommend an exclusive contract with UPMC-HP.

In addition, when the medical advisory committee began the task of reviewing the medical insurance proposals received from Highmark Blue Cross/Blue Shield and UPMC-HP, contracting solely with one of these vendors was not our intent. The committee and the staff from Human Resources were committed to providing as much choice as possible and not restricting the medical services our employees and their eligible dependents were accustomed to receiving.

Unfortunately, Highmark had its own agenda. The unrealistic cost increases, which would have been passed on to our faculty and staff, as well as the cumbersome provisions that Highmark wasrequiring of the University and its participants, were unacceptable. The committee, therefore, negotiated alternatives that would guarantee the University's commitment to choice and quality medical services.

After days of discussion, UPMC-HP agreed to provide to University of Pittsburgh medical plan participants freedom of choice and the same level of service, if not a better level of medical insurance, than that currently offered by Highmark. Each faculty and staff member who enrolls in the University's health care coverage for plan years 2001, 2002 and 2003 can choose among three plans. The HMO is a managed care plan; the POS is both a managed care as well as an indemnity plan in that it allows subscribers, at a higher co-payment and deductible, to select their own physician and facility for treatment without the encumbrances of an insurance "gate-keeper"; the Comprehensive plan is a straight indemnity plan.

Let me briefly respond to Ms. Boag's concern about the number of subscribers who will be adversely affected by this decision. Of the current faculty and staff who participate in the University's health care coverage, in excess of 80 percent of that subscriber population will not have to change their primary care physician. The remaining 20 percent will have the option to join one of the managed care plans or have freedom of choice in both the POS plan and the Comprehensive plan. A large majority of the PCPs and specialists that the current High-mark participants utilize overlap with physicians who are in the UPMC-HP network. The University and UPMC-HP are committed to assisting any subscriber whose current medical condition may qualify for transition of care.


Health Science low ratio of tenured faculty needs to be corrected

To the editor:

The low proportion of tenure-stream faculty in University of Pittsburgh Health Science schools raises serious concerns, because it threatens our entire academic tenure system. From 1974 to 1999, tenure stream positions plunged from 68 percent to 27 percent in the School of Medicine, and from 74 percent to 35 percent in other health science schools, according to the Feb. 29 report to Faculty Assembly by the Senate ad hoc committee on tenure trends (University Times, March 2, 2000).

The administration justifies hiring large numbers of non-tenure-stream faculty because they are paid from soft money (i.e., clinical revenues). Also, since they are employed chiefly for patient care, with consequently limited opportunities for research (and teaching), they do not meet academic tenure criteria. This plan undermines and threatens our academic tenure system by:

* Establishing a de facto two-tiered faculty system, in which the vast non-tenured majority works under a series of short-term contracts and lacks adequate academic freedom protections;

* Diminishing the potential for genuine shared governance between administrators and most faculty;

* Making it harder to attract and retain the best Health Sciences faculty, and foster faculty morale.

Other factors have also affected the tenure-proportion decline in our Health Science schools. As I noted at Faculty Assembly (Feb. 29), criteria for deciding tenure are unrealistically high for most faculty. E.g., I know of only one School of Dental Medicine (SDM) colleague in the last 14 years awarded tenure via the established assistant professor route. Virtually all SDM faculty tenured in that era either received it as part of their recruitment, or did not undergo the full normal review process.

To receive tenure in the Health Sciences, an assistant professor typically must obtain a three-to-five year National Institutes of Health (or equivalent) research grant as principal investigator, then succeed in renewing it by the sixth school-year. Many faculty cannot meet this tight schedule, so are temporarily removed from the tenure-stream for up to three years, to have more time to get the grant renewed.

Senior Vice Chancellor for Health Sciences Arthur Levine, recognizing the problem, proposed extending the School of Medicine's tenure clock from 7 to 10 years for clinical faculty. As a member of the University Senate tenure and academic freedom committee, I joined in unanimously approving his plan last fall because it provides candidates much-needed extra time to meet the existing stringent criteria.

Although this change is a step in the right direction, I doubt it alone will significantly reverse the drop in tenure proportions in Health Sciences. Getting a major grant renewed may well be a reasonable expectation for a faculty member essentially doing full-time research, but it is too high a tenure bar for others with heavy teaching or clinical loads. To reverse the long decline, we must either change the tenure standards or else give all faculty a reasonable opportunity to meet existing criteria.

I urge that tenure criteria in our Health Sciences be expanded to include demonstrated quality of scholarship in didactic and clinical teaching, as well as research — rather than disproportionately emphasizing grant dollars produced, as is now largely the case. Many Health Sciences faculty have been tenured in recent years without having done significant teaching, but rarely if ever is tenure granted absent a proven record in attracting external funds. In deciding tenure and promotion, quality teaching that is self-supporting, vis-a-vis the tuition revenue it generates, should receive as much credit as grant dollars. This would be a positive step toward ending our tenure crisis.

Unless faculty oppose the trend toward hiring outside the tenure-stream, it will continue to grow, and lead to a university where the vast majority of faculty lack academic freedom and are tracked into one-dimensional roles (i.e., teachers, researchers or clinicians). Tenure will then be reserved primarily for a few successful researchers and administrators. This is not conducive to a university's mission.

John J. Baker

Associate Professor

School of Dental Medicine


More to Pitt's appropriations hearing than article covered

To the editor:

As a witness to Pitt's appropriations hearing in the Pennsylvania House of Representatives earlier this month, I was surprised to see how that event was characterized in the last issue of the University Times. Contrary to your headline and article, discussion of UPMC did not dominate the session. In fact, there were only two questions relating to UPMC during the course of the entire hearing. The overwhelming majority of the questions and comments from the legislators related to issues involving the faculty, staff and students at the University. Topics discussed included tuition rates, faculty research and teaching activities, student retention and graduation rates, programs to curtail drug and alcohol abuse, efforts to prepare students for successful careers, technology transfer, and economic and workforce development initiatives. The questions asked by the legislators, both at the House hearing and at the earlier Senate hearing, reflected a significant level of knowledge and interest on their part regarding the issues facing the University.

What did not really receive any attention in the University Times, however, was the obvious respect and appreciation that the legislators expressed for the many contributions that Pitt makes to the commonwealth. Virtually every legislator at both hearings had some positive comments about the University. Items mentioned by the legislators included the University's research prominence, the quality of undergraduate education, medical breakthroughs, the contribution of our regional campuses, meeting Pennsylvania's workforce needs and helping at-risk teens. One representative even complimented the quality of the University's budget presentation. While these remarks may not have breached the threshold of "news," I do think the campus community deserves to know about the positive comments regarding their efforts and accomplishments made by our elected officials.

Dennis McManus

Assistant Vice Chancellor

Governmental Relations

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