Highmark isn't the top insurer in Western Pa. anymore, UPMC analysis says

Pittsburgh-based Highmark, the longstanding No. 1 insurer in the Western Pennsylvania marketplace, is no longer the top dog, according to the Tribune Review.

The finding is from a recent analysis by UPMC, which is based on data from a variety of sources, including CMS, Pennsylvania's Department of Human Services and the 2010 census.

Here are seven things to know about UPMC's analysis.

1. The analysis includes combined numbers from multiple markets. UPMC's analysis numbers include commercial, individual, Medicare Advantage and Medicaid managed care markets in Western Pennsylvania.

2. Western Pennsylvania is now a "tripartite" market. The market is divided into three main parts. UPMC Health Plan and Highmark each own about 28 percent of the market, each of which have about 1.09 million members, according to the Pittsburgh Post-Gazette. Other national insurers — including Aetna and UnitedHealthcare — make up 29 percent of the market and have approximately 1.13 million members. The other 15 percent of the market is accounted for by traditional Medicare and the uninsured.

3. In years past, Highmark was the top insurer in the market. Five years ago, Highmark accounted for 60 percent of the market, according to UPMC spokesman Paul Wood. UPMC's analysis found Highmark owned 36 percent of the market in 2014.

4. Between 2014 and 2016, UPMC's enrollment grew while Highmark's enrollment shrank. In 2014, UPMC Health Plan had 813,000 enrollees while Highmark had more than 1.4 million enrollees. This year, UPMC's enrollment grew to 1.095 million and Highmark's enrollment shrank to 1.092 million according to the analysis.

5. The insurers experienced different outcomes on the Affordable Care Act exchanges. UPMC's share of the ACA marketplace increased from 18 percent at the end of the 2014-15 enrollment period to 67 percent at the end of the 2015-16 period, according to Mr. Wood. During the first half of 2015, Highmark lost $318 million on the ACA marketplace, according to the Tribune Review.

6. UPMC attributes its success to two factors. According to UPMC Insurance Services President Diane Holder, these include the plan's cost and members' access to UPMC's provider network. "I think what we've moved from is one of the least competitive markets to one of the most competitive markets in the nation," she said, according to the Tribune Review.

7. Highmark declined to comment on the analysis. "It's never been our practice to comment on competitors' enrollment," spokesman Aaron Billger wrote in a statement, according to the Tribune Review. However, he added that "Highmark's enrollment remains strong with growth across Pennsylvania and West Virginia, including a 94 percent retention rate in Western Pennsylvania among employers, and a 95 percent retention rate among Medicare Advantage members."

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