Anthem and National Georgia Health Systems engage in a contract dispute and Anthem has announced a new partnership that some say may undermine the Affordable Care Act.
Anthem is preparing its members in the event that its contract with Northeast Georgia Health Systems (NGHS) ends this month, while it faces potential challenges over its new partnership with the Georgia Farm Bureau.
“Our local negotiating team has been engaged with NGHS for several months as we work toward a new agreement that would retain NGHS in our network beyond September 30, 2019,” an Anthem spokesperson told HealthPayerIntelligence.com by email.
“Our number one priority during these negotiations is to protect consumers’ access to affordable, high-quality healthcare. We believe hospitals and doctors should be compensated fairly, and this is reflected in the terms we have offered NGHS. We continue to work toward an agreement with NGHS, and are hopeful a new contract can be agreed to before the current one expires.”
NGHS serves around 40,000 Anthem members in the Gainesville and surrounding areas, according to NPR’s WABE site. The health systems have been working with Anthem—formerly Blue Cross of Georgia—for at least 15 years. Members’ access to 26 healthcare facilities and three medical groups is at stake with this contract.
According to NGHS, the negotiations began in January and have been ongoing for the past nine months.
Discussions could result in increased costs for the company’s members and employers, Anthem implied on its website . Most of Anthem’s employers, the site pointed out, are self-insured, meaning they would bear the brunt of any cost escalations since they cover their employees’ healthcare directly.
“We are actively negotiating in good faith and we believe common ground can and should be found,” the Anthem site stated.
On its website, NGHS expressed its disapproval of the new Anthem.
Critical decisions are made at Anthem’s headquarters in Indianapolis, too removed from the circumstances in Georgia, NGHS explained. The website also cited payment cuts as a divisive factor in the contract disputes.
On social media and its website, which the company built specifically for this contract dispute, NGHS has been encouraging Anthem patients, brokers, and employers to call Anthem and insist on having access to NGHS as an in-network provider.
Whether or not the contract persists, Anthem has made clear that pregnant women, those in active treatment, and those with terminal illnesses may be eligible to continue paying in-network rates for their treatments.
If the contract falls through and Anthem and NGHS terminate their partnership, Anthem members who wish to continue using NGHS services will have to pay out-of-pocket costs unless it is an emergency starting on October 1, the Anthem site clarified.
The tension between the payer and health system may be a routine contract dispute, as both Anthem and NGHS’s sites stressed, but the context is not.
The news comes months after Anthem and Wellstar ended their contract, which included coverage on the ACA exchange, in January 2019.
Anthem is also currently experiencing contract disputes with providers in California after the surprise medical bill law passed. Not far to the south, UnitedHealthcare members found themselves in a similar predicament as Georgian Anthem members earlier in 2019.
Anthem has faced another unique challenge in Georgia this year as it settles the dispute with NGHS.
Recently, Anthem started an arrangement with the Georgia Farm Bureau that aims to support rural health insurance.
The partnership established a multiple employer welfare arrangement (MEWA). This allows farmer bureau members, in groups of one to fifty, to purchase an association health plan that is not part of the Affordable Care Act (ACA) exchanges.
“GFB [Georgia Farm Bureau] members have the opportunity to participate in a larger, alternative funding vehicle for marketing health and welfare benefits to small group employers,” the Anthem spokesperson stated. “This way, they can join together to share in the overall claims risk and have financial protection backed by Anthem. The plan is medically underwritten so we can keep costs affordable, while still offering a wide variety of options and be similar to those available in the ACA marketplace.”
However, critics have expressed concern that the MEWA will attract healthier individuals away from the ACA exchanges. This could result in a spike in ACA exchange premiums as high cost beneficiaries have to bear the full brunt of the pool’s high cost treatments. Since distributing the cost of high-risk individuals is fundamental to the ACA’s structure, those who oppose Anthem’s new partnership say the move could undermine the ACA exchanges in Georgia.
The governor of Georgia, Brian Kemp, has voiced his support of the partnership and views the arrangement as a significant step in securing coverage across the rural regions of the state.
Date: September 05, 2019