From a contract fallout between two of Texas’ largest payers and providers to Mayo Health limiting UnitedHealthcare members from making appointments, here are seven recent payer contract disputes and resolutions:
1. University of Vermont Medicine Health Network (Burlington) has expressed its intent to end its contract with UnitedHealthcare over administrative and operational hurdles. About 3,000 commercial patients could be affected by the contract termination, which is slated for April 1.
2. BlueCross BlueShield of Texas and Memorial Hermann failed to renew their network contract Feb. 28, forcing the region’s largest health system out of network for 100,000 members. The parties have been negotiating since November. According to the health system, the parties had clashed over reimbursement rates, and it alleged the payer coerced physicians into unfavorable accountable care organization agreements.
3. Kansas lawmakers are going back and forth on rebidding the state’s $3.9 billion Medicaid contract, which could impact the three payers who currently hold it. Gov. Laura Kelly, a Democrat, aims to rebid the current contract, with plans to issue a request for proposals in October. The timeline would allow the state to select new payers for the contract before the current one expires in 2023.
4. Independence Blue Cross is bringing Bala Cynwyd, Pa.-based Patina Medical Group into its provider network, the payer announced Feb. 22. The primary care provider focuses on patients 65 years and older and is available to two of the payer’s Medicare Advantage plans in 2022.
5. UnitedHealthcare secured a contract to administer the District Dual Choice program in Washington, D.C. The payer will cover 12,300 individuals from Feb. 1 to Dec. 31, with the option to renew the one-year contract up to four additional times. About 39,000 people can voluntarily enroll in the program.
6. The Louisiana Department of Health will award five payers contracts to administer its state Medicaid program. The selected payers include Aetna Better Health of Louisiana, AmeriHealth Caritas Louisiana, Healthy Blue, Humana and Louisiana Healthcare Connections.
7. Rochester, Minn.-based Mayo Clinic is no longer allowing some Medicare Advantage beneficiaries to schedule appointments. The provider initially began to limit appointments during the winter months due to capacity concerns, but has now turned to “a change in enforcement” that blocks out-of-network patients from making appointments to ensure those in contracted plans have access to Mayo Clinic facilities.
Source: Beckers Payer