Highmark physician pay cuts for ACA patients challenged

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AFFORDABLE CARE ACT

HARRISBURG, Pa. – In response to Highmark, Inc.’s announcement that it will reduce what it pays physicians for treating patients with Affordable Care Act plans, the Pennsylvania Academy of Family Physicians (PAFP) is appealing to the Pennsylvania Insurance Commission to intervene.

Highmark estimates it lost $500 million last year from plans purchased on the ACA marketplace, reports TribLive. Beginning April 1, doctors’ payments will be cut by 4.5 percent. Despite many insurers incurring losses on ACA products, this may be the first time it has led to reduced payments for providers.

On behalf of family doctors statewide, PAFP President Nicole Davis, MD has written to Pennsylvania Insurance Commissioner Teresa Miller asking the Department to intervene. Given the agency’s statutory oversight, Dr. Davis, who calls Highmark’s move “profoundly disappointing,” has asked Commissioner Miller what the department can do to ensure the viability of ACA marketplace plans without negatively impacting participating physicians.

This decision is especially concerning given Highmark’s innovations on patient-centered medical home models, improving patient outcomes, and avoiding hospitalization. It also maintains several billion dollars in reserves.

The Pennsylvania Academy of Family Physicians and its Foundation supports its members (including nearly 80 percent of Pennsylvania family physicians) through advocacy and education to ensure a patient-centered medical home for every Pennsylvanian. The Academy and its Foundation are the leading influential resource among family physicians and physicians in training in Pennsylvania; the primary voice on health care issues with state legislative and administrative branches of government, media and professional health organizations; and the leader on health care issues in the community.

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