6:00: Morning News

The Health Plan and MedExpress part ways

MORGANTOWN, W.Va. — Just two days after WVU Medicine announced plans to integrate with Wheeling-based managed care organization The Health Plan, The Health Plan terminated its contract with MedExpress, a competitor with WVU Urgent Care.

The timing of that termination, however, was coincidental and had nothing to do with WVU’s acquisition of the MCO, The Health Plan said in an email exchange. The break came after months of negotiations.

The Dominion Post learned about the contract break on Monday, through obtaining a copy of MedExpress’ internal talking points memo on the topic. The paper contacted all three parties plus Mon Health System, which has a marketing relationship with MedExpress, to get their views on the matter.

On May 7, WVU and The Health Plan jointly announced their intention for WVU to acquire the nonprofit The Health Plan to form “a fully integrated healthcare delivery and financing system for the people of West Virginia.”

MedExpress spokeswoman Kelly Sorice said in an email exchange, “MedExpress was surprised to receive a termination notice from The Health Plan’s CEO that prematurely ended our existing contract, effective May 9. We asked for an extension of that May 9 date, to honor to current agreement as we hoped to negotiate rates that were amenable to both parties, but unfortunately, that extension wasn’t granted.

“This puts MedExpress’ 26 West Virginia urgent care centers out of network for The Health Plan members,” she said,” leaving them with access to only 17 other urgent care centers across the entire state. This impacts both their managed Medicaid and commercially insured members.”

The Health Plan customers seeking care at MedExpress wouldn’t be covered. The memo offers a guideline on how to explain this to patients and to offer them discounted Prompt-Pay rates for payment at that time.

The suggested language says, “Trust me, we are as disappointed as you are. If you’d like to follow up directly with The Health Plan and let them know you’d like MedExpress to be in your network, you can certainly do so by calling their member services department. … We’d love to be in your health plan’s network.”

The two companies have contrasting views on the failed negotiations.

MedExpress says in its memo, “This lack of access is troubling and shows complete disregard for the healthcare needs of our West Virginia communities.”

MedExpress contends that allegations it was “demanding exorbitant rates” are false, and it would have continued good-faith negotiations.

Sorice said, “We’d very much like serve The Health Plan members, and would love them to reinstate our current contact while we come to terms. We see no reason this can’t be worked out without impacting access.”

The Health Plan spokeswoman Wendy Hodorowski said The Health Plan costumers made about 35,000 patient visits to MedExpress last year; of those, 26,000 were Medicaid patients.

The company, she said, had a relationship with MedExpress dating back to MedExpress’ founding. It regularly reviews its agreements and determined it was paying more than 40 higher than out-of-state based MCOs. It approached MedExpress about working out a competitive rate. “We worked with them for 90 days with little or no movement on their part.”

All told, The Health Plan negotiated with MedExpress for about six months, she said. “The unfortunate timing of the termination just happened to fall two days after the announcement of the WVU integration. They were two separate events that did not have anything to do with the other.”

She continued, “We offered rates higher than our competitors pay and they refused to accept those rates. Therefore, we terminated our agreement and informed our members of other high quality, cost-effective providers to choose from.”

The Dominion Post questioned whether lack of urgent care access could divert patients to more expensive emergency rooms, which would cost The Health Plan more money.

Hodorowski said that urgent care patients often seek care there in lieu of lower cost primary care.

“The Health Plan is not trying to minimize payouts per se,” she said, “as much as THP is trying to pay a market appropriate rate for services that were paid well above the market rate. Again, THP recognizes the value and convenience of MedExpress and THP has tried to accommodate the ME requests but THP cannot pay higher than market.”

The two companies are also debating whether MedExpress is truly a West Virginia company.

MedExpress was founded in Morgantown in 2001 and has administrative offices in Morgantown and Canonsburg, Pa. In 2015, it was acquired by Massachusetts-based Optum, the health services wing of Minnesota-based UnitedHealth Group.

The Health Plan alleges, “MedExpress and United are knowingly taking advantage of THP, a West Virginia-based, not-for-profit company, whose sole mission is to provide high quality care at an affordable cost.”

MedExpress counters in its memo: MedExpress remains locally operated, with headquarters in Morgantown, and our 26 West Virginia centers are staff by West Virginia licensed doctors and nurses. Contrary to any misinformation, our relationship with Optum and UnitedHealth Group gives us access to world-class resources.”

WVU declined comment, saying “Since we have only announced our intent to acquire The Health Plan but do not yet own it, we do not have any comment about its coverage with specific organizations.”

Mon Health System President and CEO David Goldberg said the contract issue doesn’t affect Mon Health.

“Our relationship with MedExpress is very strong.” But Mon Health has its own contract with The Health Plan. And Mon Health has been expanding its primary care program through Wedgewood Primary Care.

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