Regional Payer-Provider Dispute Could Prove Unhealthy

UniNet and BCBS of Nebraska are negotiating over the renewal terms of a contract that is to expire end of August. Failure of talks could leave several hospitals and physicians out-of-network for Blue Cross members.

A regional payer-provider dispute over costs and value is showing that troubles can arise amid efforts to design reforms and move away from fee-for-service.

Blue Cross Blue Shield of Nebraska is headed to a stalemate with the multi-state health system Catholic Health Initiatives, facing an end-of-of-the-month deadline to renew a contract for CHI’s UniNet physician and hospital network.

The disagreement is centered on the contract with UniNet, a physician-led network of 2,000 doctors and 30 hospitals created in 1998 and now sponsored by CHI, after its acquisition of the 11 hospital Alegent Creighton Health — but it has come to include other CHI facilities across the state.

Failure to reach an agreement with UniNet physicians could leave a number of CHI hospitals and many employed and independent physicians out-of-network to Blue Cross commercial members in greater Omaha.

BCBSNE argues that UniNet and CHI are seeking to continue reimbursements that are far higher than peer providers, while CHI maintains that the insurer is pushing unfairly for “deep cuts” and ignoring reasonable options.

“We still want to reach an agreement and keep CHI Health doctors and hospitals in our network,” BCBSNE senior vice president Lee Handke said in a media release. “But unless they get serious about addressing their high costs in the Omaha market relative to other providers here, I’m not optimistic we will get a deal done by the August 31 deadline.”

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Source: Healthcare Payer News