In mid-July, Columbia-based University of Missouri Health Care struck a deal with some Anthem Blue Cross Blue Shield plans after being out of network for more than three months. Greg Damron, CFO of MU Health Care, told the Becker’s “CFO + Revenue Cycle Podcast” this was a “defining moment” during his first year at the system.
“We didn’t intend to be out of network,” Mr. Damron said. “Our issues that we were facing didn’t happen overnight. They were an accumulation over a number of years, and so we needed to make a pretty reasonable course correction with some of our reimbursement. That had to happen.”
On April 1, MU Health Care and Anthem split after the parties failed to reach an agreement on reimbursement rates, affecting around 90,000 members. In late June, MU Health Care and Anthem testified about the contract negotiations before a state committee.
While Mr. Damron noted the challenges patients faced during the split, he emphasized the system’s responsibility to ensure long-term viability.
“We got a lot of positive response from the community in terms of how they valued our services,” he said. “We had a lot of goodwill going in.”
He also said the experience highlighted the importance of having alignment at every level.
“[You] really have to have everybody on board,” he said. “From the board of curators … all the way down to front-line patient-facing clinicians and staff. Everybody had to be on board with what we were doing, at least understand it, and what their role was.”
Looking ahead, Mr. Damron said MU Health Care is focused on working with patients who were affected by the split to get them reconnected with their providers and to tackle billing issues.
“[Regarding] volume and revenue, just trying to make sure we’re back on the same trajectory we were before we got out of network [and] looking for growth opportunities in the area this year I think will be big.”
Mr. Damron also had advice for other hospital or health system financial leaders going through similar situations.
“If you focus on doing the right things by your patients, by your employers, by your staff [and] team members, you’re going to come out OK.”
