University of Missouri Health Care went out of network with Anthem Blue Cross Blue Shield on April 1, 2025, after contract negotiations broke down over reimbursement rates. The dispute affected commercial, ACA marketplace and Medicare Advantage plan members and lasted roughly 100 days before a new agreement was reached that July.
“Our experience being out of network last year with Anthem made us realize that there is an affordability crisis brewing out there,” Greg Damron, CFO of University of Missouri Health Care, said during a recent “Becker’s Healthcare Podcast” interview. “A lot of it is certainly focused on the pharmaceutical end of things, PBMs and so forth. But again, it comes down to those employers running up against their own fiscal constraints and the ability to afford healthcare for their employees.”
MU Health Care, the academic medical center affiliated with the University of Missouri in Columbia, entered the dispute seeking reimbursement parity with peer institutions. The system argued it was receiving rates roughly 30% below comparable academic medical centers, including the University of Kansas Health System and University of Kentucky HealthCare. Anthem characterized the proposed increases as unsustainable.
What the standoff revealed was not just a disagreement over rates but a window into the fiscal logic employers are now using to manage healthcare costs. Their choices have narrowed.
“Their choices are to figure out how to pay less, provide less, or shift more of that cost over to their people,” he said. “And there’s a tension there.”
The dispute prompted a broad revenue cycle review that is now underway, an effort examining the strength of the system’s contracting and the operational infrastructure supporting it. At the same time, the system is rethinking ambulatory access and scheduling to reduce friction for patients trying to reach its physicians, the point of contact where Mr. Damron believes MU Health Care has been unnecessarily losing ground.
“We’re very much focused on how we attract more commercial patients and how we make it easy for people to access our caregivers,” he said. “Our patients are thrilled to be cared for by our teams here, but we’re getting in our own way.”
MU Health Care operates across a 25-county footprint in mid-Missouri, a largely rural geography with a heavy government payer mix. Growing commercial volume is not just a margin strategy; it is a way to fund the access commitments the system has made to its region. That raises the stakes of every commercial relationship and makes the cost-shifting dynamic among employers a strategic concern, not just a contracting problem.
Mr. Damron sees the employer-provider tension as part of a larger structural problem that neither better contracting nor operational improvements can fully resolve on their own. Federal reimbursement pressure, employer fiscal limits and a fragmented national system are all converging simultaneously.
“No matter how you look at it, we’ve got to be much better than industry at trying to help figure out ways to solve the problems that are real,” he said.
The agreement with Anthem restored in-network access for commercial plan members, but the work that followed was its own challenge: rebuilding the patient trust and commercial volume that erodes during 100 days of uncertainty, before patients decide where they will get their care going forward.
“We spent really the rest of the year trying to regain that trust with those patients and deal with some of the aftereffects of that, and are now looking to pivot towards the future,” said Mr. Damron.
