UnitedHealthcare released a statement regarding negotiations with the Saint Francis Health Care system

UnitedHealthcare released a statement regarding negotiations with the Saint Francis Health Care system.

CAPE GIRARDEAU, Mo. (KFVS) - UnitedHealthcare released a statement in regards to negotiations with Saint Francis Health Care System.

On Jan. 27, Saint Francis Health Care System announced its changes to insurance with UnitedHealthcare.

Later that day, a spokesperson from UnitedHealthcare released the following statement. “The cost of care at Saint Francis Medical Center is nearly two and a half times more expensive than the average cost of the hospitals in our network in the St. Louis metropolitan area, where more competition among hospitals has driven costs down. Unfortunately Saint Francis has refused to address its high costs and is also demanding that we prohibit local employers from helping to lower health care costs for their employees by encouraging them to use quality, more affordable hospitals. Saint Francis is driving up the cost of health care for the people of Cape Girardeau and the companies that do business here, which is why we are working to establish a new agreement with more competitive rates. We are asking Saint Francis to join us in our commitment to providing the people of Cape Girardeau with access to health care that is not only high quality but also affordable.”

UnitedHealthcare also cited in a press release its months long negotiations with Saint Francis.

For the last several months, we’ve attempted to engage with Saint Francis to renew its contract for employer-sponsored, individual and Medicaid health plans, with the goal of renewing our relationship at rates that are affordable for the customers and members we serve.

  • In an effort to initiate productive negotiations with Saint Francis, we sent a proposal last summer. Despite repeated follow-up efforts, Saint Francis did not respond to our proposal for nearly three months, leaving us no choice but to issue a termination notice, but again, with the intent to renew our relationship.
  • We were disappointed with Saint Francis’ lack of engagement in the negotiations process throughout the summer and fall and believe we could have avoided getting to this point in the first place had the hospital simply shown up at the negotiating table and demonstrated a commitment to getting a deal done.
  • Nevertheless, we remain committed to engaging with Saint Francis and working towards the goal of reaching a new agreement. We are communicating with the hospital regularly and doing everything we can to work towards a compromise.
  • We received a proposal from Saint Francis just before the New Year in response to a revised proposal we sent in early December. Unfortunately, it remained unchanged from their original offer. Saint Francis also indicated that it is unwilling to engage with us in further negotiations unless we agree to include language in the contract that prohibits local employers from helping to lower health care costs for their employees by encouraging them to use quality, more affordable hospitals (see additional information about these contract demands below).
  • Its latest demands are taking us backwards in the negotiations and bring into question Saint Francis’ interest in reaching an agreement.
  • Instead of engaging in constructive dialogue with us, Saint Francis has chosen to focus its time and energy on planning press conferences and taking out advertisements. The hospital is unnecessarily putting our members in the middle of the negotiation. It’s unfortunate and disappointing that this is how it’s handling what should be a productive negotiations process focused on reaching a compromise and establishing a new agreement.
  • We remain open to continued discussions with Saint Francis but take seriously the impact that health care costs have on our customers and members. Saint Francis’ current contract does not align with our efforts to contain health care costs for the people we serve.

Saint Francis is not just the most expensive health system in Cape Girardeau. It’s also significantly more expensive than most hospitals in St. Louis.

  • The cost of care at Saint Francis Medical Center is nearly two and a half times more expensive than the average cost of the hospitals in our network in the St. Louis metropolitan area, where more competition among hospitals has driven costs down. This explains why so many residents in the area choose to travel to St. Louis for care.
  • Saint Francis’ high costs are unsustainable and are a major contributor to the health care affordability issues in Cape Girardeau. According to a 2013 article in the St. Louis Post-Dispatch, What remains unsaid is the price tag. The nonprofit hospitals’ charges are much higher than in other parts of Missouri — certain surgeries can even cost twice as much as those in the St. Louis area.the price tag for care in Cape Girardeau is much higher than in other parts of Missouri, with some surgeries costing twice as much as those in the St. Louis area.
  • Unfortunately Saint Francis has refused to address its high costs. While Saint Francis has stated that lowering health care costs is a priority, our data indicates that the cost of care at Saint Francis actually increased for our members in 2019.

In addition to demanding an increase in rates, Saint Francis is also demanding that we include language in the contract that restricts local employers’ ability to offer competitive health benefits to their employees.

  • Despite the fact that local businesses are struggling to continue to offer affordable health care benefits because of the high cost of care in Cape Girardeau, Saint Francis is insisting that we prohibit our customers from pursuing meaningful solutions that have proven effective at lowering health care costs in markets across the country.
  • Saint Francis does not believe local employers should be allowed to give their employees incentives for choosing quality, cost-efficient care providers.
  • Tiered networks enable employers to offer their employees a broad network of health care providers while also bringing their overall health care costs down. Offering health plans that include a tiered network of health care providers has become one of the most common ways for employers to address the problem of rapidly rising health care costs.
  • In a typical tiered network, care providers that have demonstrated an ability to deliver quality, cost-efficient care are considered tier 1, and employees are incentivized to choose these providers through lower co-pays.
  • We believe in being transparent with consumers about their health care options, including the costs and quality of care they can expect, so that they can make fully informed decisions about whether they want to use a more costly hospital for their care.

Nearly 60 percent of UnitedHealthcare members in Cape Girardeau are enrolled in self-funded plans, meaning their employers pay the cost of their employees’ medical bills themselves rather than relying on UnitedHealthcare to pay those claims.

  • When working with self-funded customers, we treat their money as if it were our own. These employer group customers have charged us with the responsibility of providing their employees access to quality, affordable health care.
  • As the prices for health care continue to rise, less money is available to pay salaries, invest in new technologies or help grow the business.
  • Establishing competitive contracts with physicians and hospitals is critical to our ability to meet our obligations to the self-funded customers we serve. That is why we are focused on reaching a new agreement with Saint Francis at rates that are affordable and sustainable for our customers and members.

We are focused on reaching an agreement that helps ensure those we serve have access to quality, affordable health care.

  • If we are unable to reach an agreement, Saint Francis Medical Center as well as its rural health clinics and ancillary providers will be out of network, effective March 5, 2020, for employer-sponsored, individual and Medicaid members.
  • Saint Francis Health Delivery Home Health
  • Saint Francis Hospice
  • Immediate Convenient Care
  • Saint Francis Rural Health Clinics
    • Kniebert Clinic
    • Charleston Family Care
    • Jackson Family Care
    • Jackson Physician Associates
    • Saint Francis Outpatient Clinic
    • Physician’s Park Primary Care
    • Piedmont Physician Associates
    • Ferguson Medical Group – Sikeston
    • Ferguson Medical Group – Charleston
    • Ferguson Medical Group – East Prairie
    • Ferguson Medical Group – Dexter
    • Ferguson Medical Group – Scott City
    • Poplar Bluff Pediatrics
  • Saint Francis does not currently participate in the network for UnitedHealthcare’s Medicare Advantage members.
  • Saint Francis physicians will remain in network until July 1, 2020.

Our top priority is ensuring the members we serve have uninterrupted access to the care they need.

  • Our members will receive letters in the mail either the week of Jan. 27 (individual and commercial members) or Feb. 3 (Medicaid members) notifying them of the potential for Saint Francis to leave the network and providing them a list of alternative in-network hospitals in the region.
  • UnitedHealthcare is committed to providing our members with access to quality health care through a broad network of hospitals at affordable rates. We are fortunate to have relationships with other hospitals in the area, including:
  • Southeast Missouri Hospital (Cape Girardeau)
  • Missouri Delta Medical Center (Sikeston)
  • Union County Hospital (Union)
  • A number of resources are available for our members to support their ongoing health care needs:
  • Continuity of Care – Members who are undergoing active treatment at Saint Francis can apply for Continuity of Care, which provides continued in-network benefits for a period of time should the hospital go out of network. Members should call the number on their health plan ID card to learn more.
  • Customer Service – Members can call the number on their health plan ID card with any questions or if they need assistance finding alternate hospitals. Our customer care advocates stand ready to serve them.
  • myUHC.com or UHCCommunityPlan.com: Members can visit their member website to search for alternative hospitals and clinics that participate in the network by using the online provider directory.
  • UnitedHealthcare members should always go to the nearest hospital in the event of an emergency, and their care will be covered at the in-network benefit level, regardless of whether the hospital participates in UnitedHealthcare’s network.

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