MEMORANDUM
From:
Senator Randy Vulakovich and Sen. Jay Costa
To:
All Senate members
Subject:
Integrated Delivery Network Contract Dispute Resolution and Patient Access & Consumer Choice Act

In the near future, we plan to introduce two bills to address contractual disputes between integrated delivery networks, such as the one occurring between UPMC and Highmark in western PA and that could arise in other areas of the Commonwealth.

Under current law, there is no mechanism to resolve contract disputes between large integrated delivery networks, like UPMC, Allegheny Health Network, and Geisinger, which could threaten patient access and choice. We propose to address contracting disputes first by focusing on hospitals operating as part of an integrated delivery network – where a large health system and insurance carrier/health plan operate under the same corporate structure. These institutions deserve special attention, as they function both as providers and payers, and therefore can have an exceptional impact on the marketplace and consumers.

There are strong consumer protection and public policy reasons for adopting this legislation. First, by requiring hospitals and physicians operating as part of an integrated delivery network to contract with all insurers, consumers will not be denied care, or worse abandoned mid-treatment, simply because they hold one type of insurance over another. All consumers should be afforded access to these vital hospital and physician services, regardless of which insurance card they carry. The legislation will also eliminate the ability of any dominant hospital system from demanding unreasonable rates for services from insurers, and in turn raising the overall cost of health care because they are the “must have” system in the area.

Please join us in co-sponsoring this legislation. If you have any questions, please call Nate Silcox (Sen. Vulakovich) at 717-787-6538 or Ron Jumper (Sen. Costa) at 717-787-7683.

Angie Armbrust
Senior Associate, The Winter Group

234 N. 3rd Street, Harrisburg, PA 17101

P: 717-909-9560 F: 717-909-9563

aarmbrust@wintergrouppa.com

www.wintergrouppa.com