UVM Health Network Proposed Plan For Current Patients Through 2023 But Was Denied
Vermont Business Magazine Since last year, The University of Vermont Health Network has worked to reach a new agreement on behalf of patients who receive commercial insurance through UnitedHealthcare. Despite many attempts to preserve patient access to care, United, one of the nation’s largest for-profit insurers, has decided to allow that contract to expire as of April 1, 2023, in line with state requirements that may lead to some coverage in New York being extended through June 1.
“This will have a serious impact on our patients who subscribe to UnitedHealthcare’s commercial insurance, and we are disappointed they have made this decision rather than attempt to come closer to payment rates approved by the Green Mountain Care Board that more accurately reflect the cost of providing health care in 2023 and align with rate increases negotiated with other Vermont payers,” said Sunny Eappen, MD, MBA, President and Chief Executive Officer of The UVM Health Network. “Our obligation is to our patients, families, staff and communities, not to UnitedHealthcare shareholders, and we will continue working hard to provide high-quality patient care while remaining one of the lowest cost health systems in the country, and doing our best to support patients who will be impacted by this decision.”
UVM Health Network proposed a plan that would have allowed current patients to continue accessing care with their United coverage through the end of 2023, under financial terms that would have had a negative impact on the health system. This would have allowed patients time to seek new insurance and treatment plans.
However, that request was denied by United, and their more than 2,600 commercial members in Vermont and northern New York will be out of network (with certain exceptions).
Resources for Patients
The UVM Health Network has set up a resource page for UnitedHealthcare members with information on how to navigate this transition. It can be found at UVMHealth.org/UnitedHealthcare.
UVM Health Network team members will provide as much support to patients as possible from the provider perspective, but for questions specific to a UnitedHealthcare plan, patients should contact United directly.
- Many patients currently undergoing a course of treatment, such as cancer treatment or pregnancy care, will likely be entitled to continued coverage at the in-network level for a transition period. Patients should contact UnitedHealthcare for specifics.
- As a safety net provider, the UVM Health Network will always provide emergency care to anyone who walks through the door, regardless of what insurance they have or whether they have insurance at all.
- Patients who are receiving health insurance through their employer should speak with them about their available options.
- Patients enrolled in health insurance through non-employer plans may wish to change insurers during the next open enrollment period in order to ensure care at the UVM Health Network remains in-network.
- Patients should work with their current UVM Health Network provider to ensure a smooth transition to a new provider if they choose. A list of in-network providers can be found through UnitedHealthcare’s website or contacting them directly.
Decision Reflects Nationwide Trends for Hospitals, Insurance Companies
UnitedHealthcare’s decision reflects a nationwide trend, as hospitals struggle under increased expenses of providing care, while many of the nation’s largest insurers – including UnitedHealthcare – continue to post profits often in the billions.
In 2022, UnitedHealth Group, United Healthcare’s parent company, distributed approximately $13 billion to shareholders. The UVM Health Network, like all of Vermont’s hospitals, is a nonprofit organization. Any operating margin is not paid to shareholders, but instead goes directly back into patient care such as through paying staff, purchasing up-to-date equipment and investing in top-tier facilities that patients deserve.
Facing significant financial, operational and workforce challenges, the Network reported a $90 million loss for fiscal year 2022.
“We’re working hard to overcome those challenges, so we can be here for our patients and communities in the long run,” Dr. Eappen said, pointing to the organization’s Path Forward financial stabilization work, as well as investments in housing for employees and plans for a new Outpatient Surgical Center that will both improve patient access and support the organization’s financial stability in the future.
In contrast, UnitedHealthcare reported revenue growth of nearly 12% year over year, to $249.7 billion in 2022. United Healthcare’s operating earnings alone (one way of describing profits) were $14 billion in 2022, dwarfing the $3.1 billion total required annually to operate the entire UVM Health Network in Vermont and northern New York.
Vermont remains the lowest cost state in the country for Medicare per capita expenditures, led by the health service areas where Network health care partners Central Vermont Medical Center, Porter Medical Center and UVM Medical Center are located. The UVM Medical Center has also recently been ranked first among academic medical centers in the country for value.
To remain solvent and continue providing patient care, the UVM Health Network and all other hospitals and health systems must negotiate reasonable, responsible insurer contracts to cover the expenses of caring for patients covered by each insurance company.
About The University of Vermont Health Network
The University of Vermont Health Network is an integrated system serving the residents of Vermont and northern New York with a shared mission: working together, we improve people’s lives. The partners are:
- The University of Vermont Medical Center
- The University of Vermont Health Network Medical Group
- The University of Vermont Health Network – Alice Hyde Medical Center
- The University of Vermont Health Network – Central Vermont Medical Center
- The University of Vermont Health Network – Champlain Valley Physicians Hospital
- The University of Vermont Health Network – Elizabethtown Community Hospital
- The University of Vermont Health Network – Porter Medical Center
- The University of Vermont Health Network – Home Health & Hospice
Our 15,000 employees are driven to provide high-quality, cost-efficient care as close to home as possible. Strengthened by our academic connection to the University of Vermont, each of our health care partners remains committed to its local community by providing compassionate, personal care shaped by the latest medical advances and delivered by highly skilled experts.
2.21.2023. Burlington, Vt. – UVMHN
