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As UPMC-Highmark split finalizes, Allegheny Health Network eyes most cancers, psychiatric services

Allegheny Health Network’s deliberate opening of an educational most cancers middle would assist shut a service hole the hospital system has acknowledged exists between it and bigger competitor UPMC.

Other gaps stay, AHN stated in a three-year plan filed with the state, and the Highmark-owned system is beefing up women’s services, emergency departments, psychiatric staffing and different areas forward of June 2019, when almost all enterprise relations are scheduled to finish between UPMC and Highmark underneath a state-brokered consent decree.

AHN stated two weeks in the past that it plans to open a $200 million educational most cancers institute via a partnership with Johns Hopkins, which can compete with UPMC Hillman Cancer Center. More bulletins are doubtless on the best way, native insurance coverage specialists stated.

“A major component of this is to let the public know that Hillman is not the only place in Western Pennsylvania you can be treated for cancer,” stated James McTiernan, space vice chairman for marketing consultant Arthur J. Gallagher & Co. “And I’m sure they’ll be making similar initiatives to make sure you know that (Magee-Womens Hospital of UPMC) isn’t the only place you can have a baby or be treated for women’s care.”

Allegheny Health Network’s hospitals supply most of the similar services as Magee, and its women’s packages — based mostly at West Penn Hospital in Bloomfield — are ranked among the many prime within the nation, stated Dr. Allan Klapper, system chairman for AHN’s Department of Obstetrics and Gynecology.

But fewer individuals comprehend it, Klapper stated, and he blames UPMC’s advertising machine and Magee’s promoting message, “Choose your care as if your life depended on it.”

“For so many years, Magee has commanded the airwaves in terms of making people fear that if you don’t go to Magee, you’re at a disadvantage in the community,” Klapper stated. “I think it does a disservice and a disadvantage to all the hospitals throughout Western Pennsylvania.”

AHN has added greater than 50 physicians within the women’s services line since Highmark shaped the system in 2013, Klapper stated. The system constructed a brand new obstetrics unit at Jefferson Hospital within the South Hills, one of many first new such models constructed within the state in years, Klapper stated.

The system has expanded perinatal melancholy remedy, added new packages surrounding births and elevated its subspecialists from 9 to 27, he stated, growing obstetrical volumes by 60 % prior to now 4 years.

UPMC responded with an emailed assertion:

“Patients have long preferred UPMC for the exceptional care — and often, unique live-saving care — that we offer. UPMC is sought out by patients in the region as well as from around the world for everything from primary care to obstetrics and women’s health services, neurosurgery, orthopedics, heart and vascular care, organ transplantation, cancer care … and many other highly complex procedures performed few places worldwide,” spokesman Paul Wood stated within the assertion.

Women’s, most cancers care

AHN’s challenges within the women’s services line of enterprise parallel challenges in different strains, the place it faces not solely actual gaps in service however what it describes within the three-year plan as perceived gaps.

UPMC had been promoting its most cancers care at the least 10 years earlier than AHN was shaped, stated Dr. David Parda, AHN Cancer Institute’s system chairman.

Despite having 23 places the place AHN sufferers can get handled for most cancers and a full vary of remedy services, the system is under-recognized, Parda stated.

“We have every possible capability and expertise and treatment option for every type of cancer and every type of cancer patient,” he stated.

He stated AHN is concentrated on streamlining most cancers remedy to scale back prices and dealing with Johns Hopkins to maintain remedy aligned with the newest nationwide advances.

If AHN can scale back remedy prices, Highmark can market the discount in claims to employers, who’re a number of the insurer’s most necessary shoppers, McTiernan stated.

The Pittsburgh Business Group on Health just lately surveyed employers concerning the consent decree, stated Diane McClune, the group’s vice chairman.

Among roughly 30 employers, about 50 % expressed concern about entry to most cancers services, greater than for another service through which UPMC specializes, McClune stated.

Overall, respondents expressed solely average ranges of concern about modifications in 2019, she stated. Employers stated they anticipated the health techniques to succeed in agreements over entry to UPMC’s Western Psychiatric Institute and to Children’s Hospital of Pittsburgh of UPMC, which is in-network for Highmark by means of 2022 by way of a unique contract.

Most of the employers indicated they might begin making particular plans in early 2018 for the top of the consent decree, and lots of have begun speaking with staff who can be most affected, McClune stated. More are providing each UPMC Health Plan and Highmark, she stated.

Psych services

Psychiatric services, not often the topic of advert campaigns, current a unique problem for AHN than most cancers remedy and women’s services.

Western Psychiatric Institute is a top-ranked psychiatric facility that conducts analysis and has 400 remedy beds.

AHN’s psychiatric beds are unfold round group hospitals akin to Allegheny Valley Hospital, Forbes Hospital and Jefferson. The system is concentrated on increasing intensive outpatient remedy and embedding psychiatrists with main care physicians to deal with psychological health points earlier than they require hospitalization, stated Dr. P.V. Nickell, AHN’s psychiatry division chair.

“We’re small, and I don’t intend to reproduce Western Psych,” Nickell stated. “That’s not what we’re about. We’re trying to take care of as many people as well and effectively as we can.”

Nickell stated he has been given assets to develop the system’s psychiatric employees, together with recruitment of specialists corresponding to geriatricians and session liaisons, who see sufferers on medical surgical flooring who may want psychiatric consultations.

The system just lately partnered with Quartet, an organization that has developed know-how to identify sufferers with bodily sicknesses who may profit from psychological health remedy, in an initiative aimed toward decreasing prices.

“As we get better at taking care of folks outside the hospital, we may need fewer beds,” Nickell stated.

AHN’s income has grown 30 % since 2013, a interval by which Highmark invested about $1 billion within the seven-hospital system, based on the system’s three-year plan.

The plan requires the health system to develop affected person discharges from a 2016 complete of about 86,000 to about 105,000 in 2020, and to extend outpatient visits from a 2016 complete of about 1.three million to a 2020 complete of about 1.6 million.

In addition to progress, AHN and Highmark’s technique is dependent upon decreasing the numbers of pricey medical services carried out by taking steps to maintain individuals wholesome, in line with the plan.

If Highmark can succeed at that, it might achieve a definite benefit within the insurance coverage market, McTiernan stated.

“If they can do it, they’ll thrive; if they can’t, they’ll struggle,” he stated.

Wes Venteicher is a Tribune-Review employees author. Reach him at 412-380-5676, wventeicher@tribweb.com or by way of Twitter @wesventeicher.

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