Insurer Highmark Inc. has taken action on two big health care issues in three months, nudging the company into the national spotlight, uncharted ground for the staid Blues affiliate.
In June, Highmark became the first health insurer in the country to stop paying doctors to perform gynecological surgery with a tool that has been linked to the spread of cancer. And in September, the company took UPMC to court over a cancer billing practice that is common throughout the country, but that can triple the cost of care without affecting quality.
Highmark President and CEO David Holmberg said Thursday that ending payments for morcellation, which is used in minimally invasive surgery on women, was a “complicated decision,” reflecting the company’s commitment to patient care and responsible management of limited resources.
“We decided to be decisive and stop paying for it until the clinical evidence suggests it’s not an issue,” he said. “We felt this was an important one for the community we serve.”
Highmark began notifying doctors in June that it would no longer pay for power morcellation effective Sept. 1. Morcellators are electric, hand-held devices that doctors use to mince uterine tissue for easy removal.
In April, the Food and Drug Administrationdiscouraged doctors from using the tool because it can spread undetected cancer, turning an isolated tumor into an advanced form of the disease.
In a break with past practice at the downtown-based insurer, Highmark took UPMC to court in September over billing practices for cancer care that can triple the cost of care, but has no effect on how well the patient does. Highmark has historically settled such disputes through closed-door arbitration.
The cancer billing issue, which is allowable by Medicare, has been percolating across the country for several years and may have reached a tipping point. The Medicare Payment Advisory Commission unanimously agreed that reimbursement for health care services such as chemotherapy should be the same, regardless of where the care is provided.
Holmberg is the third Highmark CEO is as many years, so it’s too early to say whether the company’s stand on morcellation and cancer billing marks a new course for the region’s dominant insurer.
“We’re going to be a leader on the tough issues,” Holmberg said. “We believe the most important thing we can do is to be a leader.”
Date: September 26, 2014