Premier Health, UnitedHealthcare have contract deal

Premier Health and UnitedHealthcare have agreed to a new contract, ending a seven-month dispute that affected nearly 200,000 health insurance policy holders in the region.

The two companies were unable to reach a new contract deal last May and the dispute dragged on through the end of 2017, leaving patients with Premier doctors and UHC insurance scrambling to either find a new doctor, switch insurers or pay more for out-of-network care.

“We are very happy to have found common ground and a way that Premier Health and UnitedHealthcare can work collaboratively to extend quality, patient-centered care in our communities,” said Mary Boosalis, president and CEO, Premier Health. “We look forward to working with UnitedHealthcare to continue serving our community and having a positive impact for its members who live and work in our service area.”

• Timeline: How Premier, UHC dispute unfolded in 2017

• Why the Premier-UHC dispute could hit region harder in 2018

The new contract deal was announced Tuesday and became effective immediately.

“Our priority is ensuring the people we serve have access to quality, cost effective health care,” said Kurt Lewis, CEO of UnitedHealthcare of Ohio. “Premier Health is an important community provider and partner and we are pleased to renew our relationship on behalf of the tens of thousands of people we serve across southwest Ohio.”

Details of the contract were not available but it was described as a multi-year deal.

Last year, both sides said the dispute centered around the giant insurer’s plan to rank hospitals and doctors in tiers based on cost and quality, with the stated goal of lowering the cost of health care by prompting patients to shop for cheaper care.

Premier opposed the ranking system, which it said is already steering patients away from its services and doesn’t accurately compare cost differences between its providers and other options.

Boosalis on Tuesday would not say whether tiering was a part of the new deal and said the fine details are still being hammered out.
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“I am not able to talk about the specifics of the contract. That’s part of the agreement,” she said.

She said however, that she and her board feel good about the results.

It would have been easy to get a short term deal that wasn’t in the long-term best interest of patients, Boosalis said, but said she and her board pushed for the better long-term deal.

“It was hard for any given person on any given day and I don’t think I’ll ever forget that, but we had to look at the longer term and the greater good and that’s where we landed in the end,” Boosalis said.

The contract dispute hit the region hard leaving those in the area covered by UHC out of network at Premier, the largest hospital and doctor network in Southwest Ohio.

“It was very difficult and it was very serious and I don’t take that lightly and nor does my board,” she said.

Premier’s hospitals include Miami Valley Hospital with an additional location at Miami Valley Hospital South, Atrium Medical Center, Upper Valley Medical Center and Good Samaritan Hospital. Miami Valley Hospital operates the only Level I trauma center in the region, which has the highest level of comprehensive trauma care.

Being out of contract chipped away at both parties. Premier Health said previously that its bottom line was off by “millions” because of UHC patients having their access curbed and UHC was challenged this open enrollment season with selling insurance policies that at the time couldn’t be used in-network at the largest health care provider in the region.

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Temporary agreements would have expired this month that had been letting patients with UHC pay Premier doctors with a $25 co-pay and let UHC-managed Medicare Advantage plans remain in-network with Premier.

UHC has 200,000 policy holders in the area and as of May, about 70,000 UHC-policy holders had used Premier services over the past 12 months.

Open enrollment season is over for both commercial and government insurance plans for 2018, and some Medicare Advantage policy holders and employers have already switched insurance carriers because of the uncertainty.

Dayton Public Schools, one of the largest local employers covered by UHC, switched to Anthem for 2018, in part so employees with Premier could still see their doctor.

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