The Landscape of Health Care

the Landscape of Health Care UPMC HEALTH PLAN 2006 ANNUAL REPORT One Chatham Center 112 Washington Place Pittsburgh, PA 15219 www.upmchealthplan.com winds of change Windsof Change The world of health care is one of constant movement and transition. UPMC Health Plan harnesses this energy to offer the best value to our customers, while never losing focus on our top priority: the well-being of our members. We are creating benefi t solutions and continuously fi nding new and better ways to improve our members’ health and the health of our local communities. Our extensive network offers members the fi nest health care from world-renowned medical experts, the latest medical breakthroughs, and the most innovative and effective health promotion programs in the region. Our quality, satisfaction, and cost outcomes bring value to each of our stakeholders, including the employers we serve, our members, physicians, and the community. We draw from the best to deliver the best, maximizing value and protecting the most precious resources of our community: the men, women, and children of Western Pennsylvania. President’s Letter 2 Common Ground: Network 4 Confl uence of Care: Product Portfolio 12 Reaching New Heights: Service 30 Building Bridges: Community Partnerships 34 Financial and Corporate Information 38 1 President’s Letter President’s Letter In the pages that follow, we explore the distinc- tive topography of Western Pennsylvania, At UPMC Health Plan, we understand that innovation, along as captured by with service excellence, creates the bedrock for health care Pittsburgh photogra- pher Richard Kelly. solutions that employers, members, and communities value. Our hills and rivers, as By providing competitive pricing, a comprehensive and much as our people, help defi ne our region. robust network, quality programs, and unmatched service, Here, water rushes we enable our members to receive the best health care along Slippery Rock from the region’s premier physicians, as well as exceptional Creek in McConnells Mill State Park in health promotion and wellness programs. Lawrence County. A favorite destination The past year was an exciting one for the Health Plan. for paddlers and rock climbers, the park We continued to leverage our close provider, academic, and includes the 2,500-acre Slippery Rock Gorge. industry relationships to create new programs for our members. We developed additional ways to give members tools to Staying improve their health status, including easy online access to personal health information, telephone coaching, and health improvement programs. The MyHealth program continues to support employers committed to helping their employees achieve better health. We established new approaches to improve cost and quality transparency, as well as new services such as UPMC Work Partners, which includes workers’ compensation and Diane P. Holder, President short-term disability programs. UPMC Health Plan UPMC Insurance Services Division As other health insurers consolidate nationwide, UPMC Health Plan is committed to remaining a local resource for our members. Our major focus continues to be on Western Pennsylvania, and we are proud of our efforts and results in the region. On the pages that follow, you will read about how the Health Plan and the companies of the UPMC Insurance Services Division are successfully changing the terrain of today’s health care landscape by providing products and services with our customers’ best interests in mind. As the Health Plan celebrates its 10-year anniversary, I would like to take this opportunity to thank our employer partners, our members, our physicians and hospitals, and our employees for another successful year. I am pleased to present you with this overview of our accomplishments in the past year and our vision for the future. 2 Changing the Landscape of Health Care Photo by Richard Kelly 3 Network Network CommonGroundm A shared vision of excellence At UPMC Health Plan, we think about our provider network Just steps from the University of Pittsburgh’s one member at a time. We make sure our doctors and research and medical facilities, Schenley Park offers trails and solitude hospitals are close to where people live and work, and we in the heart of the city. make sure every medical specialty is covered. Our extensive pharmacy network makes it easier for members to obtain the medications they need. But our idea of common ground goes beyond geography. We fi nd shared concerns with our customers, understanding that breadth and depth of resources matter to employers. Our shared mission with the University of Pittsburgh Medical Center (UPMC) and other providers strengthens our commitment to our members and brings greater effi ciencies to our business processes. 4 Changing the Landscape of Health Care Photo by Richard Kelly 5 Network Network Daniel Brooks, MD, is the chief operating offi cer Melissa McNeil, MD, of Sewickley Valley Hospital and chief medical is chief of the Section ® offi cer for The Medical Center of Beaver, both part of Women’s Health of To provide seamless service to our members who of Heritage Valley Health System. Heritage Valley the Division of General live or work outside of our Western Pennsylvania works collaboratively with UPMC Health Plan on Internal Medicine area, we partner with PHCS, a national provider a number of projects that involve the community at the University of network. PHCS has a network of nearly 450,000 in areas such as diabetes testing, mammography Pittsburgh. Dr. McNeil physicians and 4,000 facilities across the country. screening, and other preventive services. pioneered the integra- tion of comprehensive women’s health services as part of the practice of internal ™ medicine. MMO serves our Ohio members through its more than 190 hospitals and 20,000 physicians. A Comprehensive Hospital Network 92% of the hospitals in the Western Pennsylvania region are part of the ® UPMC Health Plan network, which includes more than 80 hospitals. Whether our members travel within the U.S. or in foreign lands, they continue to have easy access to care through our travel assistance partner, Assist America. This benefi t enables members to A Comprehensive Provider Network The physicians in our network are carefully selected locate doctors and hospitals and access emergency based on solid credentialing criteria. Every medical care. Assist America personnel can help replace 200 = Obstetrician-Gynecologists specialty is represented—there are no gaps. prescriptions, provide emergency medical Physicians 382 evacuation, and arrange transportation for family Pediatricians members to join sick or injured relatives. 444 Primary Care Physicians Specialists 2,069 4,547 A provider network without gaps Collaborating to improve care Hospitals in the UPMC Health Plan Commercial Network UPMC Health Plan has the depth and In partnership with our network providers, Allegheny County Butler County Fulton County Potter County breadth to serve every member well. we continue to ensure that members Children’s Hospital of Pittsburgh Butler Memorial Hospital Fulton County Medical Center Charles Cole Memorial Hospital Eye & Ear Institute UPMC Passavant Cranberry Our network of over 80 hospitals and get the right care, in the right amount, Jefferson Regional Medical Center Greene County Somerset County Kindred Hospital of Pittsburgh Cambria County Southwest Regional Medical Center Meyersdale Medical Center more than 7,500 physicians makes at the right time. Lifecare Hospital of Pittsburgh Memorial Medical Center Somerset Hospital up one of the most comprehensive Magee-Womens Hospital of UPMC –Lee Campus Huntingdon County Windber Medical Center In 2006 we began a program in which Mercy Hospital –Main Campus J.C. Blair Memorial Hospital teams of providers in the region. The care management professionals visit Ohio Valley General Hospital Miners Medical Center Tioga County Health Plan’s network includes 92% of Sewickley Valley Hospital Indiana County Soldiers and Sailors Memorial Hospital high-volume physician practices. These St. Clair Memorial Hospital Clarion County Indiana Regional Medical Center the hospitals in Western Pennsylvania. The Children’s Institute Clarion Hospital Venango County care managers, all of whom are regis- The Children’s Home of Pittsburgh Jefferson County UPMC Northwest For members who live or work outside tered nurses and certifi ed educators, UPMC Braddock Clearfield County Brookville Hospital UPMC Cancer Centers Clearfield Hospital Punxsutawney Area Hospital Warren County of Western Pennsylvania, we offer help members manage chronic condi- UPMC McKeesport Dubois Regional Medical Center Warren General Hospital UPMC Montefiore Lawrence County the national PHCS network of 4,000 tions. The focus is on early intervention UPMC Passavant Crawford County Ellwood City Hospital Washington County facilities and 450,000 physicians; Ohio and making sure members get the care UPMC Presbyterian Meadville Medical Center Jameson Health System Monongahela Valley Hospital UPMC Shadyside Titusville Area Hospital –North Campus The Washington Hospital residents who are members have they need—resulting in better health UPMC Sports Medicine –South Campus access to the MMO network of 190 and lower long-term costs. UPMC St. Margaret Elk County Westmoreland County UPMC South Side Elk Regional Health Center McKean County Frick Hospital Excela Health hospitals and 20,000 physicians. Western Psychiatric Institute and Clinic –St. Marys Health Center Campus Bradford Regional Medical Center Latrobe Area Hospital

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