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Blue Cross and Blue Shield of Nebraska is an Independent Licensee of the Blue Cross and Blue Shield Association. WELCOME Member Town Hall Negotiation Update.

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Presentation on theme: "Blue Cross and Blue Shield of Nebraska is an Independent Licensee of the Blue Cross and Blue Shield Association. WELCOME Member Town Hall Negotiation Update."— Presentation transcript:

1 Blue Cross and Blue Shield of Nebraska is an Independent Licensee of the Blue Cross and Blue Shield Association. WELCOME Member Town Hall Negotiation Update

2 Agenda Background and Overview Which Doctors/Hospitals are Impacted? What if an Agreement is not Reached? How do I Continue My Care? Where do I Get More Information? Questions and Answers BLUE CROSS AND BLUE SHIELD OF NEBRASKA2

3 Background Information We have had positive, productive relationships with CHI facilities and UniNet providers across Nebraska for decades This negotiation has nothing to do with the quality of care provided to our members It is about the cost of health care services in Omaha –Blue Cross and Blue Shield of Nebraska has a responsibility to our members to control health care costs Note: This does NOT impact Medicare Supplement members (except for some FEP members) BLUE CROSS AND BLUE SHIELD OF NEBRASKA3

4 Why We’re Here… We believe consumers have been kept in the dark too long about health care costs. Better decisions can be made by consumers and physicians when they have information about cost and quality. Alegent Creighton/CHI contends these negotiations should happen “behind closed doors.” BLUE CROSS AND BLUE SHIELD OF NEBRASKA4

5 This Issue is Simple… UniNet / Alegent Creighton Health costs are significantly higher—in Omaha—than other providers: 10% higher Physician costs 20% higher Inpatient Hospital costs 30% higher Outpatient Hospital costs This adds millions of dollars in excess cost for our employer groups and members in Nebraska. BLUE CROSS AND BLUE SHIELD OF NEBRASKA5

6 6 The cost of services is significantly higher at Omaha CHI facilities and with UniNet- contracted physicians This significantly drives up the total cost to treat patients

7 Who is Impacted by a Termination? Outside of Omaha, most physicians are not affected, but hospitals are BLUE CROSS AND BLUE SHIELD OF NEBRASKA7 Alegent Creighton Health -- Omaha, Schuyler, Plainview Good Samaritan Hospital -- Kearney Nebraska Heart Hospital -- Lincoln Saint Elizabeth’s Medical Center -- Lincoln Saint Francis Medical Center -- Grand Island St. Mary’s Community Hospital -- Nebraska City 1,400 + Omaha-area providers

8 Why are Facilities outside Omaha Impacted? When Denver-based CHI became involved, they moved their hospitals in Nebraska under the Omaha UniNet contract. –Previously all contracts were separate The current contract was completed in 2009 –It had annual renewals with automatic cost increases –This led to Omaha facilities and physicians becoming much more expensive than others –Rather than work with us to address the cost issue, UniNet relied on the contract for further increases. BLUE CROSS AND BLUE SHIELD OF NEBRASKA8

9 Attempts Have Failed to Focus on Omaha We have a general agreement on reimbursement for facilities outside the Omaha area –We have proposed several times to remove these facilities from this potential termination –UniNet/CHI insists on negotiating as one large organization Our intent is to limit disruption for members in communities where we have a general agreement BLUE CROSS AND BLUE SHIELD OF NEBRASKA9

10 Negotiation Overview April 23Termination Notice sent to CHI May – Aug.Weekly meetings with CHI Aug. 31 Contract terminates BCBSNE has been committed to reaching an agreement that is fair and controls costs for our members…CHI has been slow to respond, and has not addressed the cost issue. BLUE CROSS AND BLUE SHIELD OF NEBRASKA10

11 Negotiation Timeline “There have been no delays on the Uninet side, in fact it’s becoming increasingly clear that Blue Cross Blue Shield is intending to push these negotiations to the wire, or even maybe they’re intending to push UniNet out of network.” BLUE CROSS AND BLUE SHIELD OF NEBRASKA11

12 Setting the Record Straight “They (BCBS) are unwilling to leave an old, out of date business model, a fee-for-service model, and move into a value based world.” We have partnered with CHI on several programs to reward them for improving health outcomes for our members. In this negotiation, we were first to offer a comprehensive value-based proposal. We don’t believe our members should pay additional bonuses on top of CHI’s high costs BLUE CROSS AND BLUE SHIELD OF NEBRASKA12

13 CHI’s Proposals to Date… Have not offered any reduction in the costs at Omaha hospitals Have only offered a small reduction to Omaha physician costs – keeping them significantly above other Omaha health care professionals BLUE CROSS AND BLUE SHIELD OF NEBRASKA13

14 If An Agreement Is Not Reached CHI facilities and UniNet Omaha providers will be out-of-network as of September 1, 2014 BCBSNE members can then choose to: –Use a non-CHI provider or facility OR –Continue using a CHI facility/provider, which will result in a higher cost to you. –The facility or provider may also choose to bill you for the difference between what BCBSNE pays and the full amount the provider bills for a service. BLUE CROSS AND BLUE SHIELD OF NEBRASKA14

15 Finding a Non-CHI Provider BLUE CROSS AND BLUE SHIELD OF NEBRASKA15

16 Finding a Non-CHI Provider BLUE CROSS AND BLUE SHIELD OF NEBRASKA16 Customer Service Representatives are here to help tonight, if needed

17 Continuing your Care Certain conditions allow you to continue care in-network Currently undergoing: –Non-surgical or surgical treatment for cancer –Active treatment for severe or end-stage renal disease or dialysis –Active treatment for HIV and AIDS Pregnancy after first trimester or high-risk pregnancy Recent bone marrow or organ transplant; on waiting list to obtain an organ Currently receiving: –Inpatient services at a facility on the day of termination of contract –Outpatient or inpatient treatment for mental illness and/or substance abuse by a licensed mental health provider BLUE CROSS AND BLUE SHIELD OF NEBRASKA17

18 Continuity of Care Process BLUE CROSS AND BLUE SHIELD OF NEBRASKA18 Please submit application by August 31, 2014

19 Emergency Care Emergency care (ambulance and emergency room) is treated at in-network benefit levels in most cases (in-network deductible, coinsurance, etc.). Members may be billed by the provider for the difference between what BCBSNE pays for the services and the full charge from the provider. BLUE CROSS AND BLUE SHIELD OF NEBRASKA19

20 Impact to Federal Employee Program (FEP) Standard Option members will pay out-of- network rates if they use a CHI provider after August 31, 2014 Basic Option members have no out-of-network benefits unless services rendered are related to the treatment of a medical emergency or accidental illness BLUE CROSS AND BLUE SHIELD OF NEBRASKA20

21 Impact to Federal Employee Program (FEP) If you are an annuitant and Medicare is your primary coverage: Your Service Benefit Plan still covers Medicare copays and coinsurance if you have Standard Option There are no benefits available for Basic Option members BLUE CROSS AND BLUE SHIELD OF NEBRASKA21

22 Important Things to Know CHI facilities and UniNet providers are in-network through August 31, 2014—nothing changes We recommend Continuity of Care applications be submitted by August 31, 2014 Medicare Supplement members are NOT affected (except for some FEP members) Retail pharmacies and prescription drug coverage are NOT impacted—even if they are prescribed by a CHI physician BLUE CROSS AND BLUE SHIELD OF NEBRASKA22

23 Bottom Line: Taking Care of Our Members You shouldn’t have to pay more for the same health care services you can get elsewhere at better prices. As Nebraskans serving Nebraskans, we take our responsibility seriously to be a catalyst for affordable, high quality health care across our state. BLUE CROSS AND BLUE SHIELD OF NEBRASKA23

24 We’re Here to Help (844) NebraskaBlue.com/Update BLUE CROSS AND BLUE SHIELD OF NEBRASKA24

25 QUESTIONS? BLUE CROSS AND BLUE SHIELD OF NEBRASKA25


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