By Marcy Stamper
Six weeks after Confluence Health declared they were at an impasse in negotiations with health insurer Premera, the two companies announced a contract that keeps Confluence’s clinics and hospitals as in-network providers for people with health insurance from Premera and LifeWise, a Premera subsidiary.
The two companies issued a joint press release on Sept. 17 announcing the contract, which “ensures there is no disruption for Premera members who receive care at Confluence Health,” they said.
The new contract means medical care at the Methow Valley Clinic in Winthrop; a clinic in Omak; and the two largest hospitals in the region, Central Washington and Wenatchee Valley, both in Wenatchee, will be in network for people insured by Premera or LifeWise. If they hadn’t reached an agreement, 36,000 people (15% of Confluence’s patients) would have had to find a different insurer; switch health care providers; or pay the full cost for doctor’s visits, screening tests, and surgical procedures.
The resolution of the contract dispute doesn’t merely offer people more choices about their insurance coverage. For some people, it means a crucial difference in life-saving health care.
One Winthrop family panicked when they learned last month that Confluence Health would not be in their network. That meant that one of the family members would not be able to see his oncologist and other physicians who’ve been treating him for cancer. The other insurance companies that sell individual polices here also didn’t cover his doctors, they told the Methow Valley News.
Confluence said in August that Premera refused to pay a rate “consistent with other commercial insurance payers in the market.” The contract would have terminated at the end of January 2022.
Although Confluence said they had negotiated since Feb. 2020 “with minimal movement toward an acceptable agreement” and planned no additional negotiations, Premera believed there was a path to a mutually beneficial agreement.
“Negotiations are always a very artful journey, involving concession and compromise,” Premera spokesperson Courtney Wallace told the Methow Valley News. The deal benefits both companies, she said.
“The new contract represents collaboration between the two organizations that provides stability, lower costs, and the opportunity to improve patient outcomes. It also builds in hospital quality metrics, which are aligned with Washington state and national healthcare performance measures,” they said in the press release.
Specifics of the contract, including how many years it runs, are confidential, Wallace said. She deferred to Confluence to describe the built-in “hospital quality metrics” referred to in the announcement. Confluence Health representatives didn’t return calls by press time.
Confluence, like all health care providers, works with a number of payers, including Medicare, Medicaid and commercial insurance companies, and negotiates a variety of formulas for reimbursement depending on the insurer and the service provided. Some services are paid at a specific amount, and others at a percentage of the charge, according to Confluence CEO Peter Rutherford.
Confluence tries for parity so that all insurers pay the same rate for the same service, Rutherford said. But Premera has consistently paid less than other commercial insurers, Mike Tuggy, physician manager of the Methow Valley Clinic, said last month.
Premera sells insurance through several subsidiaries, including LifeWise, which is sold only through the state exchange. Premera Blue Cross offers a variety of plans through employers and the state exchange, Wallace said.
The exchange handles policies for the Affordable Care Act (Obamacare), which is the only way people can get subsidies to lower their premiums and, in some cases, lower rates for doctors’ visits and procedures.
Confluence Health is among the largest health care providers in North Central Washington, covering an area of 12,000 square miles. Premera Blue Cross provides health insurance to about 2.5 million people in the Pacific Northwest.
Options for state health insurance exchange announced
Insurers approved by the Washington Office of the Insurance Commissioner to sell polices through the state exchange in 2022 will charge an average of 4.17% more, according to the commissioner’s office.
The same three insurance companies that offered policies in Okanogan County this year have been approved for 2022 — LifeWise Health Plan of Washington, Community Health Network of Washington, and Coordinated Care Corporation. In all, 12 insurers have been approved statewide.
LifeWise requested a 6.84% increase, but the commissioner approved a 1.46% increase. Premera Blue Cross (offered in other counties, but not Okanogan) asked for a 28.98% increase, but the commissioner approved a 17.9% rate hike.
About 240,000 consumers in Washington are currently enrolled in health plans through the individual market, and 78% of those who get their insurance through the Exchange received financial help with their premiums. The average monthly premium subsidy was $400, according to the insurance commissioner.
More than 57,000 additional people were able to buy health coverage during a special enrollment period opened during the COVID pandemic. Anyone who collected unemployment insurance was eligible for tax credits.
The insurance commissioner is still reviewing rates and plans for companies that want to sell to individuals outside of the exchange (meaning they won’t qualify for discounts).
The 2022 open-enrollment period runs from Nov. 1 through Dec. 15 to buy a plan for health coverage starting Jan. 1, 2022.