Myths vs. facts

Fact: False. We reached agreement with Wellstar on a new hospital contract in the summer of 2020 that provided its hospitals with rate increases. Unfortunately, less than a year later, Wellstar issued a termination notice to our contract with egregious price hike demands of 22% in the first year of our contract as a condition of renewing our relationship.

Over the past several months, Wellstar has made minimal movement in its proposals. The system’s latest proposal seeks a more than 16% rate increase that would drive up health care costs by $56 million in just one year, which is not affordable or sustainable for the people and employers we serve.

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 significantly more expensive than all other Atlanta hospitals providing similar services. Agreeing to Wellstar’s demands for a more than 16% increase in just one year would make the rates at Wellstar’s hospitals 44% higher than the average cost of all other hospitals in Atlanta.

As if a one-year price hike of more than 16% isn’t enough, Wellstar is also seeking annual rate increases that – when combined with the health system’s egregious first-year demands – would increase the cost of care at its hospitals and with its physicians by approximately 37% over the next three years. Those annual increases, coupled with the 16% price hike in year one, would equate to a $109 million increase in health care costs over the next three years for Georgia families and employers.

Fact: False. Approximately 98% of Wellstar Clinical Partner’s (WCP) physicians participate in our commercial network through direct contracts that reimburse them at market-competitive rates, while more than 80% are directly contracted for our Medicare Advantage network. As a result, most of our members can receive care from nearly all of these physicians and take advantage of Wellstar’s clinically integrated network as of today. It’s important to note that our members will continue to have network access to those WCP physicians directly contracted with us even if Wellstar leaves our network.

However, as part of our effort to compromise, we are actively engaged in meaningful discussions with Wellstar regarding how to more fully recognize affiliated WCP physicians and have made significant progress on a new contractual arrangement. Unfortunately, Wellstar continues to spread misinformation regarding the progress we’ve made on the WCP agreement. The system is well aware the core issue that remains in our negotiation is the egregious 40% increase it’s seeking for its hospitals over the next three years, which are already the highest cost in Atlanta.

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 more than 16% 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 million to more than $5 million in just one year. 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.