Highmark fired Dr. Kenneth Melani for "gross and willful misconduct" on April 1 because of another high-profile fight that went public. The sudden downfall of Melani, who earned $4.3 million last year, left healthcare industry experts reeling. The future of financially struggling West Penn Allegheny Health System and its 11,000 employees hangs in the balance. Highmark's fortune will be at risk if it loses subscribers to UPMC Health Plan or other insurers that will offer in-network access to UPMC hospitals and doctors when the UPMC-Highmark contract expires in 2013.