An Epic Battle Has Begun. And NOT in the Supreme Court

Tom Emerick

Posted 3/26/12 on Cracking Health Costs

On the front page of yesterday’s WSJ is an article written by Anna Wilde Matthews and John W. Miller about a battle between Highmark (the Blues plan in the Pittsburgh area) and the University of Pittsburgh Medical Center.

This may be a more important event than even the current Supreme Court case over PPACA.  Let me explain why.  Click here to read the full article.

UPMC, an academic-based medical center, has been a dominant system for years.  Highmark has purchased a competing health system called the West Penn Allegheny Health System.  According to the article, “UPMC, which has its own insurance arm as well as 19 area hospitals and 3,240 doctors, says it doesn’t want to bolster a company [Highmark] it now considers a direct rival.”  Consequently, UPMC has said it will not continue to particate in the Highmark network.

At the core of this pending “divorce” is something of utmost importance to employers.  It is essentially, in my opinion, a conflict between two competing medical ethics.

What I’m expressing is my opinion based on my observations of health care in  the U.S. over the past 30 years.

UPMC represents the prevailing medical ethic in America.  Namely, if treatment or surgery may help someone, let’s do it.  Sounds reasonable, doesn’t it?  About 95% of providers in the U.S. follow this ethic.

What I believe Highmark is trying to accomplish is to save money and lives by trying to create a health system with a higher medical ethic.  The “new” and higher ethic is this.  First, work with the patient to determine the desired outcome, and second, find the safest and least invasive treatment to achieve that outcome.  This ethic is followed by about 5% of providers but include clinics such as Mayo Clinic and Cleveland Clinic.

Which ethic would an informed patient want?  The second one of course.

Which health ethic would an informed company want for it’s employees?  Let’s hope it’s the second one too.

The first or “prevailing” ethic is the main reason why we spend twice what our peer countries spend per capita on health care and get increasingly poorer results comparatively.

If we are not able to move the U.S. in the direction of the “higher” medical ethic I describe here, the consequences to the safety of the public and the health of the economy are onerous.

One thought on “An Epic Battle Has Begun. And NOT in the Supreme Court

  1. I would describe UPMC’s “ethic” in simpler terms – “keep ’em sick and keep ’em coming” – because as many have observed, that’s where the money is. The key to change is start with those who sponsor health plans, namely employers, and focus on rewarding the 5% who are doing it right and the primary care communities aligned with that 5%.

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