15 Recent Issues Between Hospitals and Payors

Written by Jim McLaughlin | April 26, 2013

Here are 15 recent issues that occurred between hospitals, health systems and payors within the past month, starting with the most recent. 

1. Aetna, Baptist Memorial Health Care Make Collaborative Care Agreement 
Baptist Memorial Health Care in Memphis, Tenn., and Aetna partnered in a collaborative care agreement to offer Aetna Whole Health, a commercial healthcare product.

2. Aetna, Carolinas HealthCare Announce Accountable Care Collaboration
Aetna and Charlotte, N.C.-based Carolinas HealthCare System are using a clinically integrated organization model to support patient-centered medical homes and other accountable care efforts.

3. Minnesota Hospitals Denounce Blue Cross Payment Changes  
The Minnesota Hospital Association called out Blue Cross and Blue Shield of Minnesota, saying the health insurer is slashing payments to rural hospitals that will "put them into deep, deep red ink."

4. Bill Requiring North Carolina Hospitals to Post Prices Passes Senate Committee 
A bipartisan North Carolina Senate committee threw its support behind a bill that would require hospitals to make their bills more transparent and comprehensible to patients.

5. CMS Rejects Pioneer ACOs' Plea for Pay-for-Performance Delay 
CMS did not accept a request from its Pioneer accountable care organizations to delay tying pay to outcomes.

6. BCBS of Tennessee, Erlanger Form Strategic Partnership 
BlueCross BlueShield of Tennessee and Erlanger Health System in Chattanooga, Tenn., signed a five-year strategic network partnership agreement, effective July 1.

7. Cornerstone Health Care, BCBS of North Carolina Form ACO 
Cornerstone Health Care, a Highpoint, N.C.-based physician group with more than 365 physicians, partnered with Blue Cross and Blue Shield of North Carolina to form an accountable care organization.

8. Pennsylvania Lawmakers: Highmark-West Penn Deal May Hurt Small Hospitals 
Four Pennsylvania state senators sent a letter to Gov. Tom Corbett, arguing the pending merger between Pittsburgh-based health insurer Highmark and West Penn Allegheny Health System could hurt small local hospitals if safeguards are not put in place.

9. Report: U.S. Healthcare System Can Save $560B in Public, Private Reforms 
If the United States tinkered with Medicare more, reformed tax policies, prioritized healthcare quality and incented states to improve care, the healthcare system could save roughly $560 billion over the next decade, according to a report from the Bipartisan Policy Center Health Care Cost Containment Initiative. 

10. UC Health, Anthem Reach New Contract 
UC Health and Anthem Blue Cross and Blue Shield of Ohio reached a new contract, meaning all UC Health hospitals and providers are now in-network again for Anthem patients.

11. Study: Bundled Payment Structures Show Promise 
When structured well, bundled payment models can be effective and profitable for hospitals that can reduce the cost of each episode of care, according to a study conducted by Singletrak Analytics and DataGen.

12. Cooper University Health Care Acquires 20% Interest in New Jersey Health Insurer 
Camden, N.J.-based Cooper University Health Care announced it will acquire a 20 percent interest in health insurer AmeriHealth New Jersey, marking the state's first hospital-payor acquisition of its kind. During a conference call announcing the deal, leaders also announced there was room at the table for more providers to join in the partnership.

13. $24M Ruling Against UnitedHealth May Enhance Payors' Scrutiny of In-Network Providers 
A Nevada jury ruled that two affiliates of UnitedHealth Group must pay $24 million in damages for negligent oversight of a physician who gave two patients hepatitis C through unsterile care.

14. Superior Health Partners, BCBS of Michigan Partner for Accountable Care 
Superior Health Partners, an alliance of eight independent health systems in Michigan's Upper Peninsula, announced an accountable care organization-like partnership with Blue Cross Blue Shield of Michigan.

15. Mountain States Health Alliance Nears Expiration of BlueCross BlueShield Contract 
The contract between BlueCross BlueShield of Tennessee and the 13 hospitals of Johnson City, Tenn.-based Mountain States Health Alliance is due to expire at the end of May, with no renewal agreement yet finalized.