Norfolk, Va.-based Sentara Health ended negotiations with Anthem Blue Cross and Blue Shield of Virginia on 2027 contract extensions for Medicare Advantage, Medicaid and ACA exchange plans.
An Oct. 5 update on Sentara’s website said the health system set an Oct. 1 deadline for Anthem to agree on proposals, but the parties were unable to reach common ground. This summer, Sentara Chief Administrative Officer Aubrey Layne Jr. told Becker’s that the organization was seeking a 6.2% blended reimbursement increase, while the insurer responded with a roughly 1% decrease.
Sentara said it is preparing to be considered out of network for affected Medicare Advantage and ACA exchange plans starting Jan. 1 and for affected Medicaid plans beginning Jan. 28.
“We are disappointed that we could not reach an agreement with Anthem on Medicare Advantage, Medicaid and exchange,” Mr. Layne said in the recent update. “However, we can no longer absorb their underpayments.”
Overall, the negotiations span Anthem plans with nearly 380,000 members, the health system said in July. Sentara said negotiations for employer-sponsored plans “will remain active for a period of time.” An Anthem spokesperson told Becker’s that Sentara has been asking for a 30% price increase for employer-based health plan patients.
“Anthem remains ready to negotiate with Sentara across all lines of business, including Medicare Advantage, Medicaid, individual and commercial,” Anthem said in a statement shared with Becker’s on Oct. 6. “We have repeatedly put forward proposals that fairly reimburse Sentara, recognize legitimate cost pressures and provide opportunities for millions more in reimbursement tied to quality and improved patient outcomes. Instead, Sentara ended negotiations on Medicare Advantage, Medicaid and individual plans after Anthem did not agree to demands that would require millions more in reimbursement than Sentara receives today.”
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