The Sanitas-HCSC venture will evaluate future expansion in the five-state region where Health Care Service owns Blues plans on a “market-by-market basis,” executives said. Financial terms of the relationship aren’t being disclosed, but those involved say Sanitas and HCSC Ventures will contribute capital to “fund the start-up of the medical centers and the joint venture will contract with Sanitas to operate the medical centers.”
A federal judge in Alabama has ruled against UPMC in its bid to allow Blue Cross Blue Shield insurance plans nationwide — other than Highmark in Pittsburgh — to contract directly with the Pittsburgh health care giant.
The ruling Tuesday by U.S. District Court Judge R. David Proctor of the Northern District of Alabama rejected UPMC’s request to intervene in a 7-year-old lawsuit against Blue Cross Blue Shield plans by some of the insurance association’s members. The ruling can be appealed.
If the ruling stands, it could restrict patient volume at UPMC’s flagship hospitals in Pittsburgh after June 30 by making it harder for anyone with Blues coverage and living outside Pennsylvania to get treated there. More than 100 million members have coverage through Blue plans nationally.
Meanwhile, in a separate lawsuit, this one in the Pennsylvania Supreme Court, UPMC rival Highmark said it is bracing for the “immediate wrecking ball” of having to pay UPMC list prices after June 30 for its members who receive emergency care at UPMC hospitals — estimating that the cost for these services could increase by hundreds of millions of dollars.
About 7,000 urology and radiation oncology patients learned this week that their doctors will be dropped from their Empire BlueCross BlueShield insurance networks effective June 1.
It’s the second time in a week that a large LI-based provider network said it was being kicked off Empire networks without warning.
In the latest move, Integrated Medical Professionals of Farmingdale, a urology and radiation oncology practice with 52 locations, said it had been informed by Empire that its doctors are being taken out of the network.
Law360 (April 17, 2019, 9:37 PM EDT) — Western Pennsylvania’s top hospital group can’t try to sever exclusive licenses between Blue Cross Blue Shield and regional health plans as part of a larger antitrust brawl over the insurance giant’s dominance of geographic areas, an Alabama federal judge ruled Tuesday.
University of Pittsburgh Medical Center — which has fought a seven-year battle with Pennsylvania nonprofit insurer Highmark over contracts with UPMC providers — has sought to intervene in multidistrict litigation involving claims that Blue Cross has flexed its powerhouse status to divvy up regional health markets.
But U.S. District Judge R. David Proctor said the hospital system’s bid to get involved in one of the suits against Blue Cross was untimely because of the complex legal fight playing out in Pennsylvania, where state Attorney General Josh Shapiro has filed court papers to ensure patients are still covered at several UPMC providers tangled in the dispute.
Law360 (April 17, 2019, 6:22 PM EDT) — Health care providers and insurance subscribers asked an Alabama federal judge to certify several classes in their sprawling litigation accusing the Blue Cross Blue Shield network of stifling hospital reimbursements and hiking purchasers’ premiums with a scheme to divvy the market among its members.
The groups centered Monday’s certification bids on Alabama hospitals, physicians and companies, as the case against the network’s Alabama affiliate will be the first to go to trial, although dozens of other Blue Cross members across the country are targeted in the long-running multidistrict litigation centered on Blue Cross members’ alleged agreements to not compete with one another.
In that same vein, the provider group — which includes emergency services facilities, surgery centers, long-term health care facilities and doctors, among others — are only seeking damages for Alabama acute care hospitals for the time being, as counsel for the providers said there’s a “crucial need” for those facilities to get relief now.
“Acute care hospitals are all the same kind of entity facing the same kind of problems, and frankly, there’s a real emergency with respect to them,” Joe Whatley of Whatley Kallas LLP, representing the providers, told Law360 on Tuesday.
Those hospitals alone are owed nearly $4.4 billion from the insurance behemoth, the providers contend, and Whatley said for the six years this case has been pending, about a dozen of these hospitals have gone out of business in Alabama.
By: Morgan Haefner
Becker’s Hospital Review
Hospitals and health systems are among the largest employers in the U.S., according to a 24/7 Wall Street analysis cited by USA Today.
Here are 16 states where hospitals are the largest employers, based on the most-recent employee counts examined by 24/7 Wall Street:
1. Alaska: Providence Health & Services (Renton, Wash.)
2. Arizona: Banner Health (Phoenix)
3. Connecticut: Yale New Haven Health System
4. Delaware: Christiana Care Health System (Newark)
5. Idaho: St. Luke’s Health System (Boise)
6. Maine: MaineHealth (Portland)
Law360 (March 19, 2019, 10:30 PM EDT) — Health care provider class attorneys on Tuesday alerted an Alabama federal judge to recent Anthem Corp. testimony in Delaware that they say contradicts Blue Cross Blue Shield Association denials that the group’s rules, including nationwide limits on member revenues from “non-Blue” businesses, are anticompetitive.
The concern appeared in a notice filed in a multidistrict litigation antitrust case against BCBS companies in the U.S. District Court for the Northern District of Alabama. The notice recapped developments during a 10-day Chancery Court trial over dueling damages claims following the collapse of the $54 billion Anthem Inc.-Cigna Corp. merger in 2017.
Witnesses for Anthem — largest of the nation’s BCBS companies — were described as giving seemingly contradictory testimony on the association’s “National Best Efforts” rule during the Delaware trial. The rule bars the association’s 36 members from deriving more than a third of their revenues from non-Blue ventures.
Although Anthem and other Blues have defended the practice as legal in the MDL, the provider attorneys noted that Anthem General Counsel Thomas C. Zielinski testified in Delaware that the company “had internally concluded that those rules were anticompetitive, and even considered a challenge to the legality of those rules,” dubbed a “nuclear option” in one instance.
Durham’s Blue Cross and Blue Shield of North Carolina is joining forces with Portland-based Cambia Health Solutions, the parent company of Regence Blue Cross Blue Shield of Oregon, to form a $16 billion affiliation covering more than six million people – with Patrick Conway as CEO.
The two not-for-profits are entering into a strategic affiliation that would mean a long-term management services contract that would include sharing management, administrative, operational and other corporate services together. The new entity will be called Cambia Health Solutions. The headquarters will be located in both Durham, and Portland, Oregon.
The “strategic affiliation” of two health insurers that operate Blue Cross and Blue Shield plans in five states makes it more difficult for Anthem to expand using the valuable Blues brand in new markets.
Cambia Health Solutions and Blue Cross and Blue Shield of North Carolina (Blue Cross NC) said this week the are forming a “strategic affiliation” that merges operations and management of two companies operating Blues plans on the East and West coasts.
That makes it less likely the larger Cambia wants to sell to the publicly-traded, investor-owned Anthem, which is the nation’s second largest health insurer and operates Blues plans in 14 states. Anthem had no comment about the Cambia-Blue Cross NC deal, but Anthem executives said earlier this month they are focused on growing and adding on to the business that they have.
It’s tough for Anthem to buy other Blues plans for a variety of reasons, making the health insurer “landlocked” as its rivals have been known to say when it comes to certain marketing.
Rules of the Blue Cross Blue Shield Association prevent Anthem from using the well-recognized Blue Cross and Blue Shield brand in regions where Anthem doesn’t have the Blue Cross license or own a Blues plan. The Blue Cross Blue Shield Association (BCBSA) is a trade group and lobby for 36 “locally operated” Blue Cross and Blue Shield companies, which are able to market their Blue brand via licenses with the association.