Originally published in The Virginian-Pilot: https://www.pilotonline.com/2023/08/12/opinion-using-vulnerable-virginians-as-bargaining-chips-must-stop/
By MONICA SCHMUDE | Guest Columnist
August 12, 2023 at 6:05 p.m.
Bon Secours Mercy Health (BSMH) has deployed a deeply concerning new tactic in its recent negotiations with Anthem Blue Cross and Blue Shield.
In short: BSMH terminated its provider contracts relating to Anthem’s Medicare Advantage and Medicaid members in an effort to raise prices for people who have health coverage through their employer or the Affordable Care Act (ACA).
As a result, on Aug. 1 about 11,000 Virginians with Anthem Medicare Advantage coverage lost access to affordable health care services at BSMH. If a resolution can’t be reached, Anthem Medicaid members will lose access on Oct. 1. This is already disrupting care for many of the most vulnerable people in our community. Anthem has been working diligently to ensure treatment continuity for people with certain serious and complex conditions. But BSMH’s decision means that most with Anthem Medicare Advantage coverage will be forced to find alternative care.
It’s important to understand how we got to this point.
BSMH and Anthem agreed to contracts for Anthem’s Medicaid, Medicare Advantage, employer-sponsored and Affordable Care Act health plan members which provided Anthem members with in-network health care access until Jan. 1, 2025.
Just one year into the agreement, BSMH wanted to raise prices for Anthem members with employer-sponsored and ACA health plans. It demanded increases more than three times the current hospital inflation rate and the annual increases agreed to in the current contract. Notably, it did not ask for more money for care received by Medicaid members.
In an attempt to force these price hikes, BSMH told Anthem that it would stop accepting Medicare Advantage and Medicaid members unless Anthem agreed to these higher employer-based and ACA prices. Thus, using these vulnerable populations as leverage to force increased payments from employers and individuals.
BSMH has been disingenuous about why this is happening. Recently, it issued a press release describing this situation as “incredibly disheartening.” But BSMH chose to become out of network for Anthem Medicare Advantage members. This was not a given “next step” in the process. Despite our requests to rescind its termination and rejoin discussions to find a reasonable solution, BSMH chose to terminate the provider contracts relating to Anthem’s Medicare Advantage and Medicaid members in the middle of the agreements.
This impacts our community.
People covered by Medicare Advantage and Medicaid are particularly sensitive to medical care disruptions. Changing doctors and finding transportation, among other factors, present difficult barriers to care — leading to missed appointments, skipped screenings and unmanaged chronic conditions. Putting these vulnerable groups in jeopardy to seek higher prices from other patients is as baffling as it is distressing for our community.
Anthem has been committed to preserving access, repeatedly requesting that BSMH continue serving Medicare Advantage members while working toward a resolution.
But BSMH terminated coverage for more than 11,000 Virginia Medicare Advantage members on Aug. 1. Starting Oct. 1, it plans to terminate Anthem coverage for almost 40,000 Medicaid members. And Virginia is not the only state it is manipulating with these tactics.
While negotiations between hospitals and health plans are an ordinary part of our health care system, BSMH’s decision to break a contract for one group of members to demand price increases from an entirely different group of members is anything but ordinary. And sadly, it’s now part of a BSMH pattern of putting vulnerable patients at risk to increase its profits.
Our ask is simple: that BSMH stop using vulnerable populations as bargaining chips and work together to reach an agreement.
Now more than ever, hospitals and health plans must collaborate to put Virginians’ best interests first. I remain committed to that course so that our families and neighbors continue to have access to high-quality, affordable health care.
Monica Schmude is president of Anthem Blue Cross and Blue Shield in Virginia.