Our Corporate Marketing team has coached me several times through what a blog is supposed to cover and given me a few pointers on format. As closely as I can tell through these discussions, blogs are meant to be a platform to express “what’s on your mind” with the hope there’s some socially or professionally relevant nugget that entices readers to continue…well…reading.

Taking that as a launching point, what’s on my mind this morning is Blake, my two-month old daughter. She awoke at a very dark hour in the morning in a fit of…joy…yes…let’s go with joy, and my morning was off to an early and interesting start. I know what you’re thinking…”Great, another blog about someone’s kids.” Not to fear, this blog will have nothing to do with my girls, and this paragraph will be the last mention of them. It will, however, have the tinge of my child woke up, pre-dawn wailing with “joy,” and you’re now reading my words through that lens. Fair?

With that as a rambling background, I get to the real heart of my blog posting — the hook as it were. The other thing that’s been keeping me up at night beyond sweet Blake (sorry, I lied about the last kiddo reference) is a recent network negotiation. One of the largest hospital systems in our local Dallas market recently went through a very vocal and very public negotiation with one of the four major carriers. As has seemingly become the norm, this negotiation played out in the court of public opinion and there were newspapers articles, emails, videos, home mailings, and yes, even blog posts!

As closely as anyone outside of the actual contracting war-room could follow, the hospital system was demanding an increase of close to $1 billion, yes, with a b. Unacceptable for the carrier to take and spread this increase across their membership, this one seemed headed for a true separation. Now I know what you’re thinking, these negotiations always seem like they’re going to break down and out of nowhere, a deal is struck at the eleventh hour and just like that everyone magically remains in the network.

However, this one really did feel different. There were daily calls and texts from our account teams at the carrier letting us know a separation was imminent, and they were preparing their teams and systems for the change.

When asked our opinion by clients, an almost unanimous “let them leave” was the message from our teams. While being sensitive to disruption in care, the bigger issue was the sustainability of the cost. How could this increase — over what was a proposed 4-year term — be justifiable to our clients and, further, to their members who share in the cost? Clients sent varying forms of communications to their members with everything from emails warning of the possibility of change to direct home mailers urging them to redirect care. The balance in these situations, having been down this path before, was the nuance between true messaging and the fear of “the boy who cried wolf” when these negotiations resolve late in the game.

Fast forward to April 1 (yes, April Fool’s Day), and guess what?! Contract ratification. A settlement by both parties allowing the hospital system to stay in the network at an undisclosed increase. So, what’s the point of this whole blog other than the not-so-surprising ending of the last-minute hail Mary that seemingly made everything right and kept the system in the network? The point is, how are we, as consumers, supposed to feel about the whole thing? While it’s fair to say there won’t be the previously alluded to $1 billion-dollar increase, there will be something. Even with a varying percentage below the original increase, I think it’s fair to assume the increase is substantial. This begs the larger question: “How much is too much?” When is it enough, and when do we start truly narrowing our networks to exclude systems based on cost? Are we ready as employers? Are we ready as consumers? Given this most recent round of negotiations, the answer seems to be not yet…but, I think we’re close.

Now, I’m off to check on Blake and read through my EOBs for the new and improved pricing. To the clients with whom I helped write emails about the network change, I apologize for the false alarm.

Sincerely,

The boy who cried wolf