Myths vs. facts

Fact: False. We reached an agreement with Wellstar on a new hospital contract in the summer of 2020 that provided its hospitals with rate increases. Unfortunately, Wellstar reneged on that agreement and issued a notice to end our contract less than one year after signing the deal, disrupting access to care for the people we collectively serve.

Throughout the entirety of our negotiation, Wellstar has refused to move off its demand for a 40% price hike for its hospitals over the next three years, including an 18% rate increase in just the first year of the contract. Agreeing to Wellstar’s proposal would increase health care costs at its hospitals by $90 million over the next three years, which is not affordable or sustainable for Georgia residents and employers.

Fact: False. Wellstar’s Oct. 3 proposal was not a counter, but rather the same exact proposal it had previously provided to us. In fact, each of Wellstar’s final three proposals included the same exact demands for an egregious 40% price hike over the next three years for its hospitals, including an 18% rate increase in just the first year of the contract.

For nearly three months, Wellstar has had a signature-ready proposal from us that provided the health system with more than fair and reasonable rate increases. However, in light of Wellstar’s lack of cooperation and continued refusal to finalize our offer, we provided Wellstar with a new proposal on Dec. 17 that provides additional concessions while still holding true to our collective goal of keeping health care affordable. We delivered this proposal in the spirit of compromise to get a deal done and put an end to the disruption the communities we serve have experienced following Wellstar’s decision to end our previous contract. We stand at the ready to work quickly to finalize the deal and urge Wellstar to sign the agreement without further delay or requesting additional price hikes Georgia residents and employers cannot afford.

Fact: False. It’s ironic when Wellstar states it wishes to modernize its contract given its refusal when we’ve offered exactly that for years.

Over the past several years we’ve proposed to Wellstar that we update its agreement to include additional performance-based programs that would incentivize improved health of its patients and our members. As part of those discussions, we’ve proposed Wellstar and its clinically integrated network, Wellstar Clinical Partners (WCP), become an Accountable Care Organization (ACO) for our employer-sponsored, individual and Medicare Advantage plans.

This arrangement would have rewarded Wellstar with additional bonus payments for achieving key quality measures that are proven to improve health outcomes for patients. Paying for performance has become an industry standard, with nearly 900 hospitals nationwide currently participating in some form of a Value-based Care model with UnitedHealthcare. Unfortunately, Wellstar has repeatedly refused.

As a result, we can only assume based off Wellstar’s egregious price hike demands that modernizing our contract is another way of saying the health system wants to significantly increase the cost of care for Georgia residents and employers without delivering any demonstrable improvement in quality.

Fact: False. Wellstar’s hospitals are already more expensive than all other Atlanta hospitals providing similar services. Agreeing to Wellstar’s demands for a 40% price hike at its hospitals over the next three years would make the rates at Wellstar’s hospitals approximately 40% higher than the average cost of all other hospitals in Atlanta by 2024.

Wellstar has repeatedly stated that the contract it is seeking would result in reimbursement similar to those from other health insurance providers. Look no further than the health plan transparency rates that were previously published on Wellstar’s website and are available by clicking here to draw the simple conclusion that this message from Wellstar is false. Please note that Wellstar removed all data related to what we were reimbursing the health system shortly after we shared the transparency information posted on the health system’s website.

Fact: False. From the onset of our negotiation, Wellstar communicated that one of its top priorities was to update our contract to more fully recognize Wellstar Clinical Partners (WCP) as a clinically integrated network. As part of our efforts to compromise, we have done just that, offering to bring the WCP physicians under one clinically integrated contract while providing WCP the rate increases Wellstar sought. Yet Wellstar continues to inexplicably communicate the false message to the community that we refuse to recognize WCP.

As Wellstar is well aware, we’ve met all of its demands with the exception of the egregious 40% price hike it is seeking for its hospitals, which are already the highest cost in our Atlanta network. Agreeing to Wellstar’s demands would increase health care costs at just its hospitals by $90 million and would make them more than 40% higher cost than the average of all other hospitals in Atlanta. Agreeing to Wellstar’s proposal would mean the average cost of care at its hospitals for people enrolled in employer-sponsored and individual plans would be more than four times what Medicare would pay Wellstar’s hospital for the same services by 2024. This is not affordable or sustainable for the people and employers we serve.

Fact: False. Health care costs continue to be a top concern for consumers and employers, and they’re relying on us to help make health care more affordable for them. That’s especially true today, as businesses throughout Atlanta struggle to keep their doors open and attract and retain the employees they need. It’s more critical now than ever that we ensure they have access to affordable health care.

Wellstar’s egregious price hike demands would significantly increase premiums and out-of-pocket costs for our members as well as the cost of doing business for companies that simply want to offer affordable health care coverage for their employees.

Wellstar’s proposal would directly drive up health care costs for our self-insured customers, given that these employers pay the cost of their employees’ medical bills themselves rather than relying on UnitedHealthcare to pay those claims. In the Atlanta area, more than 70% of our members are enrolled in self-insured plans.

Agreeing to a 40% price hike in just one year would have a significant impact on health care costs for our self-funded customers. Our largest customers would see their health care costs increase between $1.3 million to more than $9 million over the next three years. Instead of paying for Wellstar’s egregious demands, that money could enable these companies to increase wages and to help grow their businesses through things like investments in new technologies.

Fact: False. There is no secondary contract with Multiplan that provides in-network access to Wellstar.

Members who receive elective, non-emergent services at any Wellstar facility or with any Wellstar physician that have not been previously approved for continuity of care will be subject to higher out-of-pocket costs. These services will be considered out of network.

It’s unfortunate that Wellstar terminated its contract with UnitedHealthcare and is now willfully spreading misinformation in the community that will mislead its patients into thinking they can continue to receive in-network care at its hospitals and with its physicians when instead they would be subjecting them to out-of-network charges.

If Wellstar wants its claims to process in-network, it can do so by engaging in productive negotiations and rejoining our network at rates that are affordable for the people and employers we serve throughout Georgia.