ST.
LOUIS, Sept. 10, 2024 /PRNewswire/ -- After
months of negotiation with Anthem Blue Cross Blue Shield (BCBS),
Mercy has provided written notice to end its contracts with Anthem
in the state of Missouri. These
contracts include all commercial, Medicare Advantage, Affordable
Care Act (ACA) marketplace, managed Medicaid plans (Healthy Blue)
and HealthLink (which falls under the Anthem BCBS umbrella).
"Our focus remains on safeguarding our patients and ensuring
they receive the low-cost, high-quality care they deserve with
insurance coverage that provides the greatest amount of protection
for their health," said Dave
Thompson, Mercy's senior vice president of population health
and president of contracted revenue. "We know this news will be
concerning for hundreds of thousands of Mercy patients with Anthem
BCBS. We will continue to negotiate in good faith with Anthem in
hopes of avoiding any disruption to our patients at the end of the
year – particularly those patients in need of prolonged,
coordinated care. However, patients and employers considering which
health plans to purchase for 2025 should consider whether Mercy,
the largest health system in the state, will be in the plan they
purchase."
Mercy hopes to remove much of the red tape that makes it
increasingly difficult for patients to navigate Anthem's system and
creates a burden and barrier for patients to receive care when it's
medically necessary.
"These technicalities disrupt patient care and, in some cases,
can be life threatening. They are administrative tasks dictated and
mandated by Anthem, and they are a barrier to timely, appropriate
patient care and can shift the cost of health care away from the
insurance provider to those less able to afford it – our patients,"
Thompson said. "Our patients have enough to worry about as they are
often in the middle of a personal health care crisis. They
shouldn't have to worry about whether their insurance company will
approve their coverage. They should be able to solely focus on
their health and the health of their family members."
While Mercy and other organizations providing patient care face
the burden of rising costs, managed care companies are reaping
enormous profits. In June 2024,
Elevance Health, the corporate name for Anthem, reported a 24.12%
increase in its year-over-year net income to $2.3 billion and a 24.29% increase in its
year-over-year net profit margin. In stark contrast,
Mercy's average cost per inpatient stay for commercially
insured patients is 27% below the average for all hospitals in the
state and outpatient care for that same population is 16% below the
average. As a nonprofit health system, Mercy provided more
than half a billion dollars in free care in the most recently
available year, fiscal year 2023. This free care includes
traditional charity care, unreimbursed Medicaid and other community
benefits.
"The cost of providing actual care for patients has risen
significantly due to inflation, but Anthem has not kept pace with
those rising costs when it comes to reimbursing us for the care we
provide to our communities," said Thompson. "It's unreasonable for
the insurer to increase its premiums to patients and employers and
increase its profits while expecting those of us providing health
care directly to patients daily to bear the brunt of the higher
cost for providing that care."
Mercy will remain in network for medical services with Anthem
through the end of the year and will move out of network with
Anthem on Jan. 1, 2025, unless a new
agreement is reached. This notice does not impact Mercy retail
pharmacy services which will allow Mercy Pharmacy's retail
locations to continue serving Anthem patients with their current
in-network coverage.
"We're innovating to improve access to care while achieving top
performance in quality and safety. We are also keeping our costs
significantly lower than other health systems," Thompson added.
"Managed care companies can and should support this work to give
patients access to medically necessary care and incentivize those
who provide effective care and reduce the cost burden to the health
care system. We want specific provisions from Anthem to support
this work and correct issues our patients have with denials and red
tape."
Mercy encourages patients to share their concerns with Anthem by
calling the number on the back of their health insurance cards or
by calling Anthem at 1-800-331-1476 to make their voices heard.
Mercy, one of the 20 largest U.S. health systems and
named the top large system in the U.S. for excellent patient
experience by NRC Health, serves millions annually with nationally
recognized care and one of the nation's largest and
highest performing Accountable Care Organizations in quality and
cost. Mercy is a highly integrated, multi-state health care
system including more than 50 acute care and specialty (heart,
children's, orthopedic and rehab) hospitals, convenient and
urgent care locations, imaging centers and pharmacies. Mercy
has over 900 physician practice locations and outpatient
facilities, more than 4,500 physicians and advanced
practitioners and 50,000 co-workers serving patients and
families across Arkansas, Kansas, Missouri and Oklahoma. Mercy also has clinics, outpatient
services and outreach ministries in Arkansas, Louisiana, Mississippi and Texas. In fiscal year 2023 alone, Mercy
provided more than half a billion dollars of free care and other
community benefits, including traditional charity care and
unreimbursed Medicaid.
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SOURCE Mercy