What Happens When You Lose an Insurance Contract?

It seems far-fetched – or at least it did…but Highmark, who provides Medicare Advantage plans to residents in the Pittsburg, PA area, recently terminated its agreement with 8 home health agencies and 10 nursing facilities.


Highmark sites the termination of contracts based on more publicly available data from CMS.  The data, from Highmark’s perspective, provides much better insight on the operations and quality of care an agency can provide.  As agencies know, the data doesn’t always paint a complete picture of an agency. But, basing decisions based solely on data is where healthcare is going and it looks like we have arrived at the first step, with many more to climb.


In the case of Highmark, it seems as though there was an ulterior motive that is also not known yet. One of the agencies that was terminated received 4 star ratings from CMS.  Highmark reiterated that the cancelled contracts represented the best interests of its members.  We will keep you posted as more information becomes available or as other commercial insurers potentially begin to do this.