Blue Cross Blue Shield, local clinics agree to negotiate

Feb. 04--A Northland network of independent specialty clinics and primary clinics -- including Raiter Clinic, Cromwell Medical Clinic and the Human Development Center in Carlton County -- resolved a lengthy contract dispute with Blue Cross and Blue Shield of Minnesota by capitulating to the insurance company's demand to negotiate with individual clinics only.

Had the agreement not been reached, Blue Cross members would have had to pay out-of-network rates to continue using Integrity-represented facilities. The change would have affected a large number of Carlton County residents, as Sappi, the city of Cloquet, Carlton County and many other businesses contract with BCBS insurance.

As a result of the agreement announced Monday, however, Integrity Health clinics will continue to be considered in-network by Blue Cross Blue Shield, and patients at those clinics should see no disruption in their coverage.

Raiter Clinic's Dr. Ken Ripp -- who was part of Integrity's negotiating team -- said Integrity isn't going away, but each clinic will have to negotiate an individual agreement with BCBS. Integrity staff can advise on the contract negotiations, but there will be no network-wide contract like there was in the past.

"It does weaken the network," Ripp said. "But we had no meaningful negotiations with BCBS in this contract cycle and we were worried about our patients as well as the financial health of our clinics."

Integrity Health in November had alerted the public that its facilities would be out of Blue Cross Blue Shield's insurance network as of Feb. 1, as the insurer said it wanted to secure separate arrangements with the individual doctors and clinics represented by the network. Blue Cross Blue Shield said at the time that negotiating rates through a third party -- Integrity Health -- was "not in the best interest of our members."

In a news release on Monday, the insurer welcomed the agreement, saying it accomplished Blue Cross' objective.

"We are very pleased to have a new agreement and direct relationships which gives us greater opportunities to address their unique needs," said Eric Hoag, vice president of provider relations at Blue Cross, in the news release.

It isn't the end for Integrity, Ripp said. The network will continue to advise the more than 200 physicians and providers at 47 clinics and facilities in 23 communities across Minnesota and Wisconsin.

"Our clinics are pleased to have reached an agreement so that Blue Cross patients can continue to see our providers at the in-network benefit levels of their plan," Jeffrey Tucker, president and CEO of Integrity Health Network, said in a news release. "Additionally, Integrity Health looks forward to working with Blue Cross on a network-level agreement to manage costs and improve care for government programs patients."

Tucker explained what Integrity Health does is "harness economies of scale," for everything from purchasing medical equipment/supplies to contract negotiations to qualifying for federally run healthcare programs that require a certain minimum number of patients.

In addition, Integrity offers shared resources for its members, with expertise in the following areas, Tucker said:

--Mandated government and health plan reporting;

--Medical staff training and professional development;

--Risk management and clinic operations/cost reduction; and

--Quality improvement and pay for performance development, administration, training and reporting.

"We were created because it doesn't make sense for every single clinic to duplicate what we do, like create a quality improvement program for example, when they can do it under our umbrella," said Tucker, who lives in Carlton and works at the Integrity office in Duluth.

The individual clinics and BCBS are currently working on the terms of the new contract, which will cover a two-year period, Ripp said.

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