As Medicare Advantage plans are facing market consolidation due to rising costs and federal funding cuts, The Virginian-Pilot and Inside Business reached out to other Hampton Roads health systems about potential impacts.
Sentara Health announced this month its insurance division is discontinuing some Medicare Advantage plans, effective Dec. 31, and, in turn, the system is laying off about 220 employees. Medicare Advantage is the privatized version of Medicare.
CVS Health’s Aetna, Humana and UnitedHealth Group also said they expect to scale back on Medicare Advantage plans across the country next year, according to Reuters. Rising health care costs and changes to government funding are leading major insurance carriers to reduce their offerings in less profitable regions.
Bon Secours, following months of contract negotiations, is alerting patients who have Humana Medicare Advantage and Medicaid health plans that they may lose in-network access to their providers by the end of the year. The health system said more than 11,000 patients could be affected.
If an agreement is not reached by Jan. 1, Bon Secours hospitals, physicians, urgent care centers, ambulatory surgery centers and other care sites in Hampton Roads will be considered out-of-network for those Humana plans, the health system said in a release. Emergency department services would still be covered.
“When reimbursement rates are not sustainable and claims are frequently denied, it creates uncertainty and barriers to care for these patients and their families,” Pat Davis-Hagens, Bon Secours’ Hampton Roads market president, said in the release. “We remain committed to resolving these negotiations thoughtfully and working to protect our patients from any gaps in their access to care.”
Humana, which is offering a number of plans in Hampton Roads next year, remains at the table negotiating in good faith and has offered proposals to reimburse Bon Secours at rates that are fair and reasonable, spokesperson Cait Whatley said.
“These discussions are focused on achieving a balanced solution that prioritizes affordability, care quality and long-term sustainability for our members,” Whatley said in an email.
Bon Secours, like other health systems, is navigating significant economic pressures driven in part by low reimbursement rates from health insurance companies and the broader impact of inflation, spokesperson Jenna Green said.
Chesapeake Regional Healthcare plans to continue accepting Medicare Advantage plans, President and CEO Reese Jackson said. He acknowledged that expected disenrollment in Medicare Advantage plans and coming cuts to federal Medicaid funding are alarming.
“While of great concern, there are no plans for layoffs,” he said.
Newport News-based Riverside Health’s president and CEO, Dr. Mike Dacey, said while no health system can give guarantees, particularly in the current environment, the organization has no plans for layoffs.
“Working with over 10,000 team members and medical staff over the past 24 months, we have reduced our expenses in areas ranging from supply chain to travel staff and have continued to grow in important clinical areas, enhancing our market share as our operational efficiency has improved,” he said.
Those efforts are shoring up Riverside with roughly $150 million annually, which the health system estimates will be enough to offset substantial federal payment reductions, Dacey said.
Riverside is in active negotiations regarding Medicare Advantage plans, he said.
“We have noted the exit of a growing number of health systems across the country from these plans and agree that many of them benefit insurance companies at the expense of patients and the health care system overall via denial of needed care and excessive bureaucracy,” Dacey said.
Sandra J. Pennecke, 757-652-5836, sandra.pennecke@pilotonline.com
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