Negotiations between major insurance provider Anthem and Yale Medicine — the clinical faculty of the Yale School of Medicine — came to an end early Wednesday afternoon when the two parties came to a multi-year agreement that ensures that customers on Anthem’s insurance plans will continue to benefit from the services of Yale Medicine doctors at the network-subsidized rates, according to a Wednesday press release from Anthem.
Anthem and Yale Medicine reached the agreement two days before the existing contract was set to expire at midnight on Oct. 7. If the two parties had failed to reach an agreement by Oct. 8, Anthem members would have faced higher out-of-network rates if they wished to take advantage of services offered by Yale Medicine.
“We are pleased our members will continue to have access to Yale Medicine’s providers,” said Anthem President Jill Hummel in a press release shortly after negotiations concluded. “This collaboration presents an excellent opportunity for Anthem and Yale Medicine to work together to improve patient health and outcomes.”
According to Anthem, under the new agreement, the two organizations will broaden their relationship by implementing new approaches to managing cost and quality that provide value to their mutual constituents. As per the agreement of both parties, the terms of the contract will not be released.
In an email to the News, University spokeswoman Karen Peart said that the new contract will protect in-network access to Yale Medicine providers for commercial, Health Insurance Exchange, … Medicare Advantage and Managed Medicaid health plan members for the entire 2017 health care benefit year.
Hummel added that Anthem is particularly excited by the new agreement’s focus on patient-centered care.
In a release, Yale Medicine CEO Paul Taheri said the agreement was a “recipe for success” because it gave providers the tools and resources needed to focus on prevention, wellness and the coordination of care.
Yale Medicine and Anthem — one of the two insurance providers in Connecticut’s state insurance exchange program — have been involved in a dispute over contract terms since Yale Medicine issued a notice of termination earlier this year. According to Taheri, the notice of termination and the ensuing process of contract renegotiation are routine occurrences.
Yale School of Medicine Dean Robert Alpern said that disagreement over the rate Yale Medicine would charge Anthem was the main point of contention in the negotiation process. Taheri however, added that Yale Medicine was also concerned by what he characterized as the burdensome administrative requirements of their current contract with Anthem, including the extensive paperwork required to file claims.
Yale Medicine is the largest multispecialty practice in New England, with over 1,400 physicians, while Anthem is one of two insurance providers on the state’s health care exchange that will continue to provide cover into 2017. Given the essential role of both parties in Connecticut’s health care landscape, their failure to reach an agreement less than 72 hours before the point at which thousands would have incurred greater health care costs has drawn criticism from public representatives.
State Senate President Martin Looney, D-New Haven, wrote to Taheri and Hummel last week, urging them to reach a swift resolution and lambasted both parties for engaging in a “cruel game of brinkmanship.”
In a press release Wednesday evening, Looney applauded Anthem and Yale Medicine for coming to an agreement.
“Today’s announcement is welcome news for Anthem customers who rely on Yale Medicine,” Looney said. “Moving forward, it is critically important that the consolidation of the health care market not leave patients without access to affordable, quality care.”
Peart added that with the new calibrated contract in place, Yale Medicine and Anthem can continue growing their commitment to “programs that reduce the rising costs of health care, while providing the transparency needed” in order to reassure patients that their interests are being prioritized.
Prior to 2014, Anthem was known as WellPoint.