Six months ago, Premier Medical Associates in Monroeville loomed as the big prize between dueling health giants Highmark and UPMC. But to hear Premier CEO Mark DeRubeis, the bitter public contract battle between UPMC and Highmark had little or nothing to do with the group's decision. At the public hearing about the Highmark-WPAHS partnership two weeks ago, Mr. DeRubeis referred to troubles in Pittsburgh's healthcare arena as "a dangerous distraction" from the real problem—the national healthcare crisis. Western Pennsylvania's higher-than-average hospital use has driven up costs here even more than other regions, he said.