MarinHealth, Anthem Blue Cross reach agreement on new contract

After months of failed negotiations, MarinHealth and Anthem Blue Cross on Tuesday reached an agreement on a new contract, the day it otherwise would have terminated, according to a joint statement from both parties.

The new contract provides Anthem members with in-network access to care at MarinHealth facilities and its affiliated physicians, and protects affordability for consumers, according to the joint statement. The new agreement applies to Anthem Blue Cross consumers enrolled in HMO and PPO plans.

MarinHealth in March had notified Anthem of its intent to terminate the hospital contract if an agreement wasn’t reached by Sept. 15, Anthem said last week.

“We are pleased to have come to an agreement with Anthem Blue Cross,” said MarinHealth CEO Dr. David Klein, who on Sept. 1 took the helm from Lee Domanico, who retired Aug. 31 after 10 years leading MarinHealth. “Providing access to high-quality care for our community has always been, and will continue to be, our top priority. With this new agreement, Anthem Blue Cross patients can continue to rely on MarinHealth for their health care needs.”

Anthem responded in kind.

“Our members remained our No. 1 priority as we worked hard and in good faith to find common ground and reach an agreement that helps achieve greater affordability,” said Beth Andersen, president, Anthem Blue Cross.

Anthem in a statement last week alleged MarinHealth was demanding substantial increases in reimbursement rates at the hospital “despite already being one of the most expensive hospitals in the state.”

Common procedures at the hospital, the insurer previously said, cost “far more” than at other Bay Area health care facilities. “For example, the average costs associated with a colonoscopy with biopsy at (MarinHealth) are in the $13,000 to $16,000 range, and costs associated with the alternate hospitals are in the $3,000 to $7,000 range.”

Jamie Maites, vice president, marketing and communications at MarinHealth, last week told the Marin Independent Journal that the hospital’s rates were “highly competitive. A third-party review found MarinHealth to be in the middle of the pack when compared to approximately 40 other Bay Area hospitals.”

Last year, Anthem and NorthBay Healthcare reached an impasse over contract negotiations, as previously reported in the Business Journal.

After negotiations fell apart in May 2019, NorthBay Healthcare and Anthem agreed on a new three-year contract that was signed two months later, in August. The agreement brought both NorthBay Medical Center and NorthBay VacaValley Hospital back into the network, and retained NorthBay physicians and specialists.

The immediate impact was that Anthem’s members who had been seeing NorthBay physicians and specialists could again be served in NorthBay hospitals. During stalled negotiations, patients were being diverted from NorthBay to other hospitals or surgery facilities, according to NorthBay Healthcare and Anthem.

The agreed-upon contract covers Anthem members with PPO, EPO POS and PPO/EPO plans. Those with an Anthem Blue Cross Medicare Supplement plan options A-N were not impacted by any of the negotiations.