It has been brought to our attention that though we have renewed our contract with Anthem BC/BS, Anthem’s system has not reactivated our providers and services in their network. Therefore, patients may be receiving conflicting information regarding Memorial Health System being in network. Please be assured that Anthem BC/BS is in our network and we will honor the financial obligations of patients as such when they receive our services. Anthem anticipates this being resolved within a week.
Memorial Health System is pleased to share our health system will remain in network with Anthem BC/BS for members of Blue Cross/Blue Shield Plans. The negotiation between the health system and Anthem has been finalized.
The agreement will remain in place through 9/30/22.
"We are pleased to have reached this multiyear agreement that provides Anthem BC/BS patients access to the high quality, low cost care provided through our providers, clinics, outpatient centers and hospitals," says Memorial Health System president and CEO Scott Cantley, "We are appreciative of your patience as we worked through this important negotiation."
Memorial Health System will keep its Resource Center open for walk ins through January 31 and available by phone through February 7 to answer any remaining questions.
Memorial Health System continues to negotiate with Anthem BC/BS in good faith to resolve contract details and ensure access to quality, affordable health care in our region.
Our most recent proposal to Anthem agrees to accept reimbursement rates – what Anthem pays the health system for services performed for its members - at the same level we’ve been receiving in the current contract. This would mean a range of between 3.7 and 4.3 percent increase depending on performance metrics set forth by Anthem BC/BS.
Anthem’s proposal incorporates an additional experimental reimbursement rate that would impose significant cost to the health system to implement. This is a methodology that less than one percent of hospitals in Ohio have agreed to with Anthem.
Specifically, Anthem is requesting the health system establish fixed prices in multiple areas such as Emergency Department visits and surgeries. Setting fixed prices in these settings will require a considerable amount of resources and costs to monitor, audit and adjust. Our health system would have no choice but to pass that cost on to our community over time. This doesn’t make sense given the goal of our health system, and reportedly Anthem, to work to make care more affordable.
It’s important to note that while Anthem continues to voice that Memorial Health System’s cost of care is high, the Federal Government has shown that we are exactly at national average in cost expressed as Medicare spending per beneficiary. This can be visualized in the chart below where .99 is the national average cost.
Memorial Health System has more than 120,000 items in its Chargemaster system and while some charges may be higher than national averages, others are lower. The system goes to great lengths to keep prices at the national average, continually monitoring its charges and works with a third-party vendor every few years to audit costs.
Anthem has suggested patients can receive care at Camden Clark Medical Center if Memorial Health System is not in network. This is not in line with their own cost of care philosophy as shown in the chart above. Camden’s cost is proportionately higher than Memorial Health System costs, and above the national average, according to Medicare and the federal government.
A New York Times article at the end of 2018 also confirms the high cost of care at Camden Clark Medical Center. The full article can be found here, https://www.nytimes.com/2018/11/14/health/hospital-mergers-health-care-spending.html. The article shares that when hospitals merge and there are fewer in the market, prices rise. The below chart calls out that Camden Clark’s merger with WVU Medicine was the largest increase in cost of care in the nation, raising costs upwards of 54%.
We understand these negotiations can be worrisome for our community, but they are critical to our ability to keep quality, local, affordable care. Please be assured we are doing all we can to minimize disruption of care. We want to ensure we can continue to serve our community for years to come, providing access to high quality health care close to home. We understand the time sensitivity of this issue and appreciate your patience in this process.
This week negotiations continue to move in a positive direction. We continue to negotiate in good faith and have moved a step closer to a common ground that would be mutually agreeable. We understand this can be worrisome for our community. Please be assured we are doing all we can to minimize disruption of care. We want to ensure we can continue to serve our community for years to come, providing access to high quality health care close to home. We understand the time sensitivity of this issue and appreciate your patience in this process. Please feel free to contact our resource center, listed on this page, in the event you have questions regarding your coverage.
Memorial Health System received Anthem’s response late last week and Memorial Health System responded on January 7, 2020 with a proposal of compromise, which we hope can bring the negotiation to an end. We await Anthem's formal response. In the meantime, please expect Anthem to mail out the formal termination notice letters to their members notifying them of our January 31, 2020 network termination. We are continuing our negotiations and are making every effort to meet an equitable agreement over the course of the next few weeks.
As of this week, negotiations with Anthem have moved in a positive direction, and we are encouraged on recent discussions towards a solution. Because of the progress we have made, Anthem has requested to shift the termination date from December 31, 2019 to January 31, 2020 to allow for additional time for our negotiating teams to work towards a solution that will benefit our community. Memorial Health System has agreed to this extension. This means that Memorial Health System and all of our providers will be in network with Anthem through the end of January 2020.
We will continue to keep the community updated on the progress of these negotiations. Please check back here for continuing updates. We anticipate our next update to the community will be mid-December.
We appreciate your patience during this time, and we look forward to a full resolution in the near future.