The following contract disputes and agreements involving hospitals, health systems and insurers were reported within the past few weeks, beginning with the most recent.
1. UnitedHealthcare dropping Carolinas HealthCare System
As of Feb. 28, Charlotte, N.C.-based Carolinas HealthCare System physicians and hospitals are set to no longer be considered in-network for UnitedHealthcare members. UnitedHealthcare and Carolinas HealthCare System are still involved in negotiations over the contract, but efforts did not show much promise for reaching an agreement as of Feb. 17.
2. Insurer disputes hit Rush, University of Chicago Medicine
Relationships between health insurers and some of Chicago's most prominent hospitals are undergoing some change. The 20-year relationship between Humana and University of Chicago Medicine will come to an end April 1, when the three-hospital system will be eliminated from the insurer's network. The change will affect approximately 1,750 patients. Also, Blue Cross & Blue Shield of Illinois has notified 65 medical groups that they will face reduced reimbursement, effective Jan. 1, to physicians if they refer BCBS HMO patients to Rush University Medical Center, a four-hospital network. Rush, to avoid this business threat, is cutting its reimbursement rate for those patients.
3. Bronson Healthcare, Blue Cross Blue Shield of Michigan agree to 5-year contract
Bronson Healthcare, based in Kalamazoo, Mich., and Blue Cross Blue Shield of Michigan reached a five-year contract agreement that will allow people insured by BCBSM and Blue Care Network HMO to maintain access to Bronson hospitals. The parties had been engaged in a contract dispute, and if they had not reached an agreement by Feb. 15, Bronson could have become an out-of-network healthcare provider for BCBSM customers.
4. Highmark membership suffers as patients seek plans with full UPMC access
An ongoing contract dispute between Highmark and Pittsburgh-based UPMC may have lent some benefit to Aetna and other insurers providing in-network access to UPMC. The dispute allowed those other payers to take over some of Highmark's market share in the western part of Pennsylvania. As of January, Highmark had a 60 percent market share in that 29-county region, down from 63 percent in January 2014. The decrease was driven by a loss of 150,000 employer-group members who were concerned about keeping discounted access to the UPMC. Aetna, on the other hand, added approximately 150,000 members in western Pennsylvania in the last year.
5. Christ Hospital terminates contract with Horizon BCBS of New Jersey
Horizon Blue Cross Blue Shield of New Jersey announced Christ Hospital in Jersey City, N.J., terminated its contract with the insurer, effective Jan. 30. A transition period will allow BCBS members to use Christ Hospital through May 31, but as of June 1, it will no longer be an in-network hospital.
6. Sutter Health reaches agreement on contract with Blue Shield of California
Blue Shield of California and Sacramento, Calif.-based Sutter Health ended a month-long dispute in late January when the two agreed to terms for a new two-year contract, which runs through December 2016. The last contract between Blue Shield and Sutter expired Dec. 31, 2014, and the dispute affected approximately 280,000 people, who were notified by the insurer that they would need to find another provider or face higher out-of-network costs by April 1.