Months after a contract battle between a regional insurer and Tacoma-based health system was resolved, a new impasse has erupted between a different insurer and the same health system.
This time, Premera Blue Cross, based in Mountlake Terrace, and MultiCare are stalled in their negotiations and have made their opposing views known.
Patients represented by Premera Blue Cross started to receive notifications this month that if the two sides cannot reach agreement, MultiCare providers, clinics, hospitals and facilities would no longer be in their network starting June 1.
The current contract ends May 31.
"This was not something Premera pursued — we want them to stay in network and our efforts are aimed at that," Premera said in an update posted online April 15.
MultiCare shared its own statement Friday in response to questions from The News Tribune.
"Since 2019, Premera has reimbursed MultiCare well below the rate of inflation," the health system said. "This is not sustainable and jeopardizes access to 1,000 health care providers and multiple hospitals, urgent cares and health clinics across the state."
The insurer countered on their website that they seek to "Fairly compensate the hospital system while remaining competitive in the market," in keeping costs low.
Premera Blue Cross covers an estimated 100,000 members who currently use MultiCare services/providers and an additional 3,300 Medicare Advantage members, according to the insurer.
Those potentially affected include "all lines of business, including commercial, individual, UW student insurance, and Medicare Advantage plans," Premera said April 15. "This does not impact members who have coverage through a Premera Medicare Supplement plan or are on the HMO plan with the Sherwood network."
Potentially affected MultiCare sites are spread across King, Pierce, Spokane, Thurston and Yakima counties.
Medicare Advantage clients were the first to receive their Premera letters about the situation this month; all others potentially affected will receive their letters later in April.
Not the first time
If all of this sounds familiar, that's because MultiCare was in similar situation at the start of the year.
In February, MultiCare and Regence BlueShield, another regional insurer, reached an agreement a few weeks after going public in that contract dispute.
Bill Akers is executive vice president at Premera Blue Cross. He told The News Tribune in a Friday phone interview that work on a new contract started off much like Regence described its process.
"They didn't start the negotiation with a proposal — they started the negotiation with the termination notice," Akers said, adding the notice arrived "before the end of 2023."
"We didn't actually receive their first proposal to us until several weeks later, maybe six or eight weeks later," he added.
The new rates MultiCare is proposing, Akers said, are "just not sustainable for our customers."
Scott Thompson, MultiCare media representative, told The News Tribune via email Friday that the health system was still in negotiations with Premera.
"While disrupting patient care is not our desire, our mission of partnering for healing and a healthy future has become much more difficult as we manage rising costs driven by inflation, staffing shortages, and insufficient insurance reimbursement rates that do not match increased costs," he wrote.
"Maintaining a sustainable health system requires collective efforts, particularly from the health insurers who reimburse our hospitals and doctors for the care we provide to their members — our patients," he added.
Contract terminations
The starting-talks-with-termination factor is a recent phenomenon, as both a Regence executive and now Akers have cited in their experiences.
"I think it's a fairly common thing, unfortunately, now," Akers said. "We have had some recent negotiations that have started with a termination. And up until the very recent history that ... that's highly unusual. It's less unusual now than it used to be."
All of this now seems far from their relationship status in 2021 when MultiCare and Premera announced an expanded alliance "to keep health care costs flat for (the) next five years," according to a news release at the time.
"Premera and MultiCare have had a really collaborative relationship, especially over the last five to seven years," Akers said when asked about the pair's alliance announced in 2021.
"We've tried a number of different innovative approaches around care.," he said. "And we've supported different program development together in the Pacific Northwest, including a primary care program for rural medicine, (which) we put a significant amount of resource and financial support into."
"We've probably done more things on the partnership and collaboration side with MultiCare than anyone else in the last several years," he added. "So it's disappointing from our standpoint, given all of that, we're in this kind of conversation 30 days or 40 days from the end of the agreement."
For now, he noted, "We're still fairly far apart."
As for MultiCare, it stated in Friday's email to The News Tribune that it was negotiating "for a more equitable agreement." On its website, its message to patients was more blunt:
"You rely on us to serve you well. We rely on Premera to pay us fairly."
The health system added that for now, "There will be no changes for patients, who should continue to seek care at MultiCare as usual. Appointments can still be scheduled, and care received at all MultiCare locations with our health care providers."
For more information
MultiCare has a page online dedicated to contract updates, as does Premera on its site.
Premera said on its website that "If an agreement isn't reached by May 31, 2024, we will work with members that may need ongoing support due to chronic or complex conditions to ensure their treatment isn't disrupted."
In a statement sent to The News Tribune, the insurer explained that under such circumstances, "Some members may be able to continue their care at MultiCare and continue their current in-network benefits for up to 90 days."
It added "This may apply if they're receiving treatment for a complex or chronic medical condition, which could include pregnancy or scheduled nonelective surgery. Members can contact customer service at the number on the back of their member ID card for more information about this process."
its page referred customers seeking a new primary care provider to go to their Premera accounts online and use its Find a Doctor tool. It also recommended considering Kinwell primary care, which also offers in-network services for Premera members, at kinwellhealth.com.
Kinwell has 16 primary care clinics in the state, plus a statewide virtual care clinic, according to Premera, with the Federal Way clinic closest to Tacoma. There also are clinics in Olympia, Renton and Seattle.
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