WVU Medicine deal leads to provider contract cancellation at CAMC

CHARLESTON, W.Va. — CAMC (Charleston Area Medical Center) has informed Wheeling-based health insurance carrier, The Health Plan, it will terminate its contract at the end of this year, impacting several thousand state residents in 14 southern West Virginia counties who are covered by the provider.

Jim Pennington

The Health Plan President Jim Pennington tells MetroNews CAMC is upset that his company has agreed to become a subsidiary of WVU Medicine.

“They (CAMC) pretty much told me straight to my face that, ‘Jim, this has nothing to do with The Health Plan, you guys have done everything that you indicated that you would. You’ve honored all of our agreements, you’re a great partner, but you’re now a partner of WVU Medicine and based upon that we’re not going to keep doing business with you,”” Pennington said.

According to Pennington, CAMC doesn’t like WVU Medicine’s recent management agreements with smaller hospitals, several of them in CAMC’s territory.

“CAMC sees that as an aggressive play on WVU’s part. In our meeting they called them ‘the northern aggressor’ several times,” Pennington said.

WVU Medicine has made management deals with Jackson General Hospital in Ripley and Summersville Regional Medical Center in Nicholas County.

In a ‘Frequently Asked Questions’ document forwarded to MetroNews by CAMC Monday evening, the hospital disputes the number of patients that will be impacted by the termination decision. Pennington said it would be up to 50,000 residents. According to CAMC, it’s more like 3,200 (non-Medicaid) patients.

CAMC President and CEO Dave Ramsey

“CAMC participates in a variety of other health plans and networks and our community will continue to have access to care,” a statement from CAMC said. “Once we made the decision not to renew, we told them in July so that The Health Plan as well as their beneficiaries had plenty of time to prepare for 2020.”

Pennington said he asked the hospital for a six-month extension to provide more time to work through the issues but the hospital refused.

“They told me point blank there wasn’t any term we could modify that would change their mind,” Pennington said.

The Health Plan will begin informing its members Tuesday by letter of the change that’s coming at the end of the year. Pennington said he’s hopeful that will give their members, who have his company as their private insurer, enough time to choose another provider. It will also impact residents covered by Medicare. Pennington said their only choices will be a few out-of-state companies like United Healthcare based in Minneapolis, Minnesota or Highmark Blue Cross/Blue Shield based in Pittsburgh.

“It’s not The Health Plan out of West Virginia,” Pennington said. “For someone to attack a West Virginia not-for-profit firm at the benefit for out-of-state for-profit firms really just doesn’t settle well with me,” Pennington said.

The Health Plan also covers about 14,000 people who receive coverage through the state’s Public Employees Insurance Agency (PEIA). CAMC has agreed to extend that agreement through next June at the request of PEIA Executive Director Ted Cheatham.

Pennington said CAMC’s decision, which will bring to a close a 10-year relationship. He said it’s unnecessary.

“We spend almost $50 million a year there now and at their request we just gave them an increase three months ago on their Medicaid discount,” Pennington said.

The Health Plan will try not to cut jobs because of the termination decision but Pennington said it will have a big impact. The company employs approximately 500 people including about 100 in Charleston.

Pennington said he anticipated the deal with WVU Medicine may not sit well with everyone but he didn’t expect contracts to be terminated.

Albert Wright

“Marshall Health, Cabell Huntington, Wheeling Hospital, Weirton Hospital, we have contracts with everybody,” he said. “CAMC is the only one that sent us a termination notice.”

The Health Plan is now entering contracts with other providers of services that CAMC provides. Pennington said one such deal is with a Roanoke, Virginia hospital that provides open heart surgery services. He said many southern West Virginia residents covered by his company will be sent there.

The WVU Medicine-Health Plan deal was announced in May calling it “a fully integrated healthcare delivery and financing system for the people of West Virginia.” The deal becomes final next July.

CAMC claims it has been trying to work with WVU Medicine for the last three years on a collaborative agreement but WVU decided against it.

“Mr. Wright (WVU Medicine President and CEO Albert Wright) has been publicly presenting in multiple forums that he believes West Virginia should have only one health care system, and that WVU Medicine is the only organization that can provide the needed levels of specialty care. We strongly disagree with this sentiment. CAMC continues to focus on initiatives that benefit the citizens of West Virginia, including quality specialty services,” CAMC said Monday.

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