17 Recent Issues Between Hospitals and Payors

Here are 17 recent issues that occurred between hospitals, health systems and payors within the past several months, starting with the most recent.

1. The total cost of the transaction between West Penn Allegheny Health System and health insurer Highmark, both based in Pittsburgh, was originally estimated to be around $475 million, but now the costs will be more than triple that at $1.6 billion.

2. Legacy Salmon Creek Medical Center in Vancouver, Wash., signed a seven-year deal with Kaiser Permanente Northwest to treat the insurer's 100,000 local beneficiaries in network, replacing nearby PeaceHealth Southwest Medical Center's previous agreement.

3. Aetna announced new Medicare Advantage contracts that add more than 20 Ohio hospitals and systems to its network.

4. More than 18 commercial payor accountable care organizations were announced from November to January, most of which involved Cigna.

5. After allowing its contract to expire in November, BayCare Health System in Clearwater, Fla., reached a five-year agreement with UnitedHealthcare.

6. AtlantiCare Regional Medical Center, a two-hospital system with campuses in Atlantic City and Pomona, N.J., inked a new contract with Aetna.

7. University of Pittsburgh Medical Center signed a deal with Aetna to join Aetna's Medicare Advantage network.

8. Anthem Blue Cross and Blue Shield allowed its contract with Middlesex Hospital in Middletown, Conn., to expire after months of botched negotiating, but the two sides renewed a multiyear contract.

9. New Jersey's largest non-profit integrated health system, Barnabas Health, signed a multiyear deal with Aetna.

10. After ending its contract with Highmark in September over failed payment renegotiations, Bethlehem, Pa.-based Coordinated Health agreed on a new multiyear contract that would keep its two hospitals and clinics in Highmark's network.

11. Ending a yearlong feud over reimbursement cuts, Chicago-based Rush University Medical Center and Aetna signed a three-year deal that would keep the system in Aetna's coverage network.

12. In December, providers in North Carolina called for judicial review of a finding that allows insurers to change some reimbursement policies without renegotiation.

13. Gateway Health Plan, a managed care plan that covers Medicare and Medicaid beneficiaries in Pennsylvania, ended its Medicaid contract with three area hospitals, all of which are operated by Naples, Fla.-based Health Management Associates.

14. Memorial Health Care System in Chattanooga, Tenn., and UnitedHealthcare agreed to new terms on a reimbursement contract.

15. After more than a year and a half of severed ties, UNC Health Care in Chapel Hill, N.C., and Aetna agreed to a new three-year contract.

16. Hartford (Conn.) HealthCare and UnitedHealthcare reached a new multiyear contract, which includes performance-based incentives.

17. Chet Burrell, CEO of CareFirst BlueCross BlueShield, the largest health insurer in Maryland, said hospitals are "the single biggest driver" of the state's healthcare cost woes.

More Articles on Hospitals and Payors:

ACO Readiness: 6 Chief Determinants
Seeking External Validation: Q&A With the Crystal Run Healthcare ACO Team
Tenet Expects Commercial Rates in Health Insurance Exchanges

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