Healthcare Advocate Victoria Veltri called on Eastern Connecticut Health Network (ECHN), the Eastern Connecticut Physicians Hospital Organization (ECPHO) and health insurance carriers United/Oxford, Anthem and ConnectiCare to immediately set to work on resolving their contract disputes. The disputes are leaving patients confused and uncertain about their access to care and could jeopardize the viability of provider practices that participate with the three carriers. At issue is the potential failure of an entire system of care east of the river that provides thousands of Connecticut residents with primary, specialty and hospital care.
“While it’s not uncommon for carriers and hospitals and carriers and physician organizations to engage in protracted negotiations, in this case there are three contracts in dispute at the same time. One, the United/Oxford and ECHN hospital contract, is already terminated, the ConnectiCare/ECPHO contract is in an extension and the Anthem contract is set to expire on December 31st. Each party is responsible for delivering on the promises made to consumers for accessible, quality healthcare. Right now, accessibility is in serious question, particularly under the United/Oxford and Anthem contracts.”
The contractual disputes between ECHN and Anthem and ECHN and United are for hospital based services, but the contracts affect patients who seek care at providers affiliated with the hospitals. While ECHN providers who perform procedures at Manchester and Rockville Hospitals have been encouraged by United/Oxford to obtain privileges at other hospitals, Veltri says this is easier said than done. “Obtaining privileges at other hospitals is not a simple practice. And for specialists, there are often concerns about ability to schedule OR time and pressure from other practices already affiliated with the hospital to prevent specialists from obtaining privileges, among other issues.”
Veltri is concerned for patients who may have signed up for insurance plans expecting to be able to see or continue treatment with ECHN hospitals and ECPHO providers. “When we buy an insurance policy we don’t expect to be suddenly left without in-network providers or hospitals. While these disputes carry on, people are still paying a monthly insurance premium for a policy that has lost significant value to them.”
Veltri also notes that the uncertainty of the three contracts may unintentionally place provider practices in jeopardy as each of the carriers is informing ECHN/ECPHO providers that they can no longer or may no longer be able to see patients on an in-network basis. Veltri states, “I’ve been told by multiple ECHN /ECPHO providers that their contracts with United/Oxford, Anthem and ConnectiCare amount to up to 80% of their practice volumes. Each of these provider offices is a small business, the viability of which may be called into question because of the contract uncertainties.”
Veltri notes that she cannot get involved in individual contract discussions, but “we can make ourselves available to assist in getting the negotiators to the table with realistic proposals as soon as possible.”
The number of high profile contractual disputes between carriers and hospitals reported this year point to the need for substantial reforms in payment models, service delivery design and contracting processes.
“Ultimately, I think it’s important to remind all parties that while they are discussing the monetary value and structure of contracts, at the heart of this issue are patients. The bottom line is that we are really deciding is whether a cancer patient can continue to access his care with the oncologist he’s worked with for years, whether a woman in the late first trimester of pregnancy can continue care with the OB-GYN she’s seen for five years or whether a patient with a serious mental illness can maintain his relationship with his long-term psychiatrist. The choice of a provider is at the heart of a high quality doctor-patient relationship and the assurance of coordination and continuation of care.”
Veltri hopes that reminding ECHN, the ECPHO and the carriers of their duties to the patients and enrollees that keep them in business will prompt more urgent action. “Time is ticking. Get it done.”
Consumers are encouraged to call the Office of the Healthcare Advocate’s toll-free line at 1-866-466-4446 for assistance with accessing healthcare services.
