MMIT Payer Portrait: UPMC

UPMC Health Plan is the health insurance unit wholly owned by the University of Pittsburgh Medical Center (UPMC). UPMC operates a health system of 40 hospitals throughout Pennsylvania and Appalachian regions of New York and Maryland, as well as several international locations. Its health plans serve members across the spectrum of insurance products, including Pennsylvania’s managed Medicaid program and the Affordable Care Act exchanges. It is currently the third-largest insurer in the state. Cigna Corp.’s Express Scripts serves as UPMC’s primary pharmacy benefits manager, while Accredo Health Group, Inc. (a unit of Express Scripts) manages specialty pharmacy. UPMC manages its own behavioral health benefits.

More than half of UPMC’s members are enrolled in a public-sector plan, with managed Medicaid serving as the insurer’s largest business sector at 41% of overall enrollment. UPMC’s Medicaid enrollment soared amid the COVID-19 pandemic, growing by more than 23% from the second quarter of 2020 to the present. Prior to the pandemic, managed Medicaid represented 35% of UPMC’s enrollment.

UPMC has largely weathered the financial woes caused by the pandemic. The health system reported income of $1.1 billion in 2021, with revenue up 5.5% from 2020. “UPMC’s successfully integrated provider-insurer model enables our organization to be strong and nimble in fulfilling our mission of always providing the very best, value-based clinical care, even during challenging times,” Diane Holder, UPMC Health Plan’s president and CEO, said in a news release. Among UPMC’s cost management strategies for health plan members are its housing investments, which aim to assist its Medicaid beneficiaries experiencing homelessness with housing placement, and a meal pilot that launched just a few months before the pandemic began. UPMC told AIS’s Health Plan Weekly that it saw a 36% reduction in the median total cost of care and a 31% decrease in emergency room use during the six-month period after the meal service ended. On the hospital side, UPMC has worked to mitigate the impact of the COVID-fueled nursing shortage by launching its own travel staffing agency.

SOURCE: AIS’s Directory of Health Plans as of May 2022; MMIT Analytics as of 2Q 2022.

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