ST. LOUIS – Mercy and Anthem Blue Cross and Blue Shield in Missouri (Anthem) have reached a new multi-year agreement providing Anthem members with continued access to care at all Mercy hospitals, outpatient care centers and physician offices across Missouri.
With the new contract, Anthem members covered by Anthem employer-based, Medicare Advantage and Affordable Care Act Marketplace health plans in Missouri will have uninterrupted in-network access to Mercy doctors and care sites.
Missouri Care, Inc — doing business as Healthy Blue — has reached an agreement for the Healthy Blue Medicaid plans as well. Healthy Blue members will have continued uninterrupted in-network access to Mercy doctors and care sites.
In a statement released by Mercy in September, Mercy wrote, “After months of negotiation with Anthem Blue Cross Blue Shield (BCBS), Mercy has provided written notice to end its contracts with Anthem in the state of Missouri. These contracts include all commercial, Medicare Advantage, Affordable Care Act (ACA) marketplace, managed Medicaid plans (Healthy Blue) and HealthLink, which falls under the Anthem BCBS umbrella.
Dave Thompson, Mercy’s senior vice president of population health and president of contracted revenue, said at the time, “Our focus remains on safeguarding our patients and ensuring they receive the low-cost, high-quality care they deserve with insurance coverage that provides the greatest amount of protection for their health.
“We know this news will be concerning for hundreds of thousands of Mercy patients with Anthem BCBS. We will continue to negotiate in good faith with Anthem in hopes of avoiding any disruption to our patients at the end of the year — particularly those patients in need of prolonged, coordinated care. However, patients and employers considering which health plans to purchase for 2025 should consider whether Mercy, the largest health system in the state, will be in the plan they purchase.”
According to Thompson, Mercy hoped “to remove much of the red tape that makes it increasingly difficult for patients to navigate Anthem’s system and creates a burden and barrier for patients to receive care when it’s medically necessary. He went on to say, “These technicalities disrupt patient care and, in some cases, can be life-threatening. They are administrative tasks dictated and mandated by Anthem, and they are a barrier to timely, appropriate patient care and can shift the cost of health care away from the insurance provider to those less able to afford it — our patients.
“Our patients have enough to worry about as they are often in the middle of a personal health care crisis. They shouldn’t have to worry about whether their insurance company will approve their coverage. They should be able to solely focus on their health and the health of their family members.”
Mercy’s stance was that while it and other organizations providing patient care faced the burden of rising costs, managed care companies were making “enormous profits.” According to Mercy, in June of this year, Elevance Health, which is the corporate name for Anthem, reported a 24.12 percent increase in its year-over-year net income to $2.3 billion and a 24.29 percent increase in its year-over-year net profit margin. At the same time, Mercy said that its average cost per inpatient stay for commercially insured patients was 27 percent below the average for all hospitals in Missouri and outpatient care for that same population was 16 percent below the average.
Mercy claimed that, as a nonprofit health system, it provided more than half a billion dollars in free care in fiscal year 2023 that included traditional charity care, unreimbursed Medicaid as well as other community benefits.
Thompson said, “The cost of providing actual care for patients has risen significantly due to inflation, but Anthem has not kept pace with those rising costs when it comes to reimbursing us for the care we provide to our communities. It’s unreasonable for the insurer to increase its premiums to patients and employers and increase its profits while expecting those of us providing health care directly to patients daily to bear the brunt of the higher cost for providing that care.”
In September, Mercy pledged to remain in-network for medical services with Anthem through the end of the year but would move out-of-network with Anthem as of Jan. 1 unless a new agreement was reached, excluding Mercy retail pharmacy services.
Thompson said, “We’re innovating to improve access to care while achieving top performance in quality and safety. We are also keeping our costs significantly lower than other health systems. Managed care companies can and should support this work to give patients access to medically necessary care and incentivize those who provide effective care and reduce the cost burden to the health care system. We want specific provisions from Anthem to support this work and correct issues our patients have with denials and red tape.”
Now that its new contract with Anthem is squared away, it appears that Mercy has received the “specific provisions” it was demanding.
