Two sides “never stopped talking” after 2011 rift
By Scott Robertson
Photos by Scott Robertson
Almost three years to the day after Mountain States Health Alliance and CIGNA announced they would no longer be doing business together, the two companies have reached agreement on a new deal that will once again allow Cigna customers to access Mountain States facilities and services at in-network rates. The three-year agreement goes into effect Oct. 1.
Mountain States COO Marvin Eichorn discusses the three-year agreement with CIGNA.
CIGNA, the insurer that serves Eastman Chemical Company, has around 21,500 souls in the Mountain States coverage area. More than 80 percent of those are employees of Eastman Chemical Company and their dependents.
The Eastman relationship proved a key in establishing a new working agreement between MSHA and CIGNA, said Paula Claytore, MSHA VP of Managed Care, whose team handled the negotiations. “There are a lot of new payment models coming out now. In continuing our partnership with Eastman, they are very interested in those models, so we found some avenues there that we could start building blocks on. That was a big piece of it.”
That ability to explore new payment models helped the firms get past what had in the past been the largest hurdle in negotiations, the price of MSHA’s services. “(Price) usually is (the sticking point) in these matters,” said Eichorn. “As time has gone on and other factors have entered into the picture, we have been able to reach an agreement at a competitive price for businesses and individuals in the community.”
Mountain States VP of Managed Care Paula Claytore was instrumental in negotiating the deal.
Both sides entered into these negotiations with a slightly different mindset than they had in 2011, added Claytore. “There was more of a willingness to be more transparent on both sides. That helped a lot in working through the details.”
Claytore said that the changing healthcare marketplace drove both sides toward that willing spirit. “The environment has changed a lot. Looking at consumers and the online tools they have now, the high-deductible plans, and their ability to determine how they’re going to spend their dollars, over the last three years a lot has evolved. The members, the patients, the community, they have such an awareness of those types of things. All of that fed into this.”
“We’ve evolved too,” added Eichorn. “We’re in the bundled payment plan with Medicare under a couple of conditions at three of our hospitals in one case and one hospital in the other. We are putting together a system of care here that’s going to take care of people before they enter into an acute care phase of their condition as well as on a post-acute basis. We’re being very proactive in trying to keep them from having to use the system at all. So we’ve evolved. We’re not there yet. We’ve still got miles to go but I think we’re making good progress, and I think CIGNA recognized some of those things about us.”
That recognition came in part because MSHA and CIGNA never stopped talking, even after the 2011 break-up. “We kept up contact with CIGNA,” said Eichorn. “We’re not an organization that ever wants to burn bridges with anybody. So we kept up a dialogue with CIGNA for the whole time since we went out of their network. Last fall it began to look like we would be able to get some things worked out.”
Eichorn said the move had nothing to do with the rumored possible merger with Wellmont Health System. “Again, this has been in the works for 11 months, long before (Wellmont’s plans to seek a merger partner were) ever announced. This is in no way associated with anything to do with what might possibly happen there.”
“We are pleased to expand our offerings with the addition of Mountain States Health Alliance to our network, and look forward to continuing to provide our customers with access to quality, customer-focused and cost-effective health care,” said Rich Novack, Cigna’s president and general manager for MidSouth markets, in a press release.
