March 2017 Contracting Update

The SFHCP Contracting Team has been engaged in the following agreements over the past quarter:

Anthem: SFHCP has inched closer to successfully negotiating the first ever Anthem Physician Hospital Agreement. As of February 2016, we have a high-level agreement in place and are close to finalizing the deal. We will disseminate more information upon conclusion of our negotiations.

ConnectiCare Exchange: an amendment to enhance the hospital and physician rates was completed effective February 1, 2017.

ConnectiCare ACO: we continue to negotiate a new agreement with CCI for both Commercial and Medicare Advantage members. Our prior agreement had been terminated on 12/31/16.

ConnectiCare Podiatry Rates: we successfully negotiated a plan to include all of our Podiatrists in our existing agreement with an increase effective August 1, 2017.

Tufts Medicare Advantage: we finalized an agreement with Tufts for an April 1, 2017 effective date that will allow members to be referred to from the Massachusetts market to Saint Francis Hospital and Medical Center and be seen by our physicians.

Corvel: we completed two Worker’s Compensation amendments for both Johnson Memorial Hospital and Saint Francis Hospital and Medical Center with increased rates for both the hospital and physicians.

Harvard Pilgrim: negotiations are underway for an amendment for both the hospital and physicians. SHFPC recently passed a credentialing audit and is now working toward a delegated credentialing agreement so that SFHCP will be able to credential all members directly with Harvard Pilgrim.

United/Oxford: SFHCP continues to work with the payor to resolve prior authorization and denial issues pertinent to cardiology cases as well as the disruption in our ACO Medicare Advantage agreement as a result of error in their attribution file and PCOR reports that contain gaps in care updates. SFHCP continues to streamline the roster validation process with the payor.

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