Issue link: https://beckershealthcare.uberflip.com/i/501108
28 Financial Management Hospital-Insurer Disputes: Are Things About To Get Ugly? By Ayla Ellison S everal high-profile disputes between health systems and insurers made headlines in recent months, with some of those disagreements leading to contracts expiring without a new one in place. The failed negotiations between UnitedHealthcare and Charlotte, N.C.-based Carolinas HealthCare made headlines in February. That same month, it was announced that a 20-year relationship between Humana and the University of Chicago Medicine would come to an end April 1, affecting approximately 1,750 patients. Rush University Medical Center was also involved in heated insurer negotiations, as Blue Cross & Blue Shield of Illinois notified 65 medi- cal groups they would receive reduced reimbursement if they referred BCBS HMO patients to Rush. One of the most controversial provider-payer disagreements involved Pittsburgh- based UPMC and health insurer Highmark. The contract dispute between the two grew to such proportions that the government considered intervening. Penn- sylvania lawmakers drafted legislation that would force UPMC and Highmark to work together. In June 2014, the organizations executed a consent decree and put a five-year transition plan into place. However, even with the consent decree gov- erning their post-contract relationship, UPMC and Highmark have continued to battle over the interpretation of certain language contained in the document. There have also been some last-minute agreements reached. For instance, in January, after weeks of negotiations, Blue Shield of California and Sac- ramento, Calif.-based Sutter health reached a deal and entered into a new two-year contract. "It comes down to employers, the government and consumers wanting more value." — Ben Isgur, Director of PwC's Health Research Institute