Froedtert South, Anthem reach new agreement

Negotiations went down to the wire

Paul Nobile of Anthem Blue Cross and Blue Shield in Wisconsin
Paul Nobile of Anthem Blue Cross and Blue Shield in Wisconsin

Froedtert South and Anthem Blue Cross and Blue Shield in Wisconsin announced they have reached an agreement that will keep the health care provider in Anthem’s network through Dec. 31, 2020.

The previous agreement between Anthem and Froedtert South expired on Dec. 31, 2017, but negotiations pushed up against the deadline, leaving patients uncertain about their coverage in the new year.

Negotiations between the health care provider and insurer played out more publicly than usual, after Froedtert South ran print ads in the Kenosha market informing patients of the possible loss in coverage at the end of the year.

Paul Nobile of Anthem Blue Cross and Blue Shield in Wisconsin
Paul Nobile of Anthem Blue Cross and Blue Shield in Wisconsin.

Several factors complicated the negotiations, including Milwaukee-based Aurora Health Care’s recent plans to merge with Downers Grove, Illinois-based Advocate Health Care, said Jim Mueller, longtime insurance industry executive and current president and CEO of Mueller QAAS.

“Aurora wanted that market share to move from Froedtert South to Aurora, so they were putting pressure on Blue Cross,” Mueller said. “Paul Nobile (president of Anthem Blue Cross and Blue Shield in Wisconsin) knows that the employer community, with low unemployment, wants a provider network with everyone in. And Blue Cross of Illinois didn’t want to disrupt the access for employees that live in Kenosha.”

“So you had different interests,” Mueller added, “Aurora – and ultimately, Aurora-Advocate – pressure on Blue Cross, you had the Blue Cross national network, Blue Cross of Illinois, and then the local (Anthem Blue Cross and Blue Shield in Wisconsin) interested in what’s best for their company, and Froedtert interested in what’s best for their organization holistically.”

Froedtert South’s print ads likely placed increase pressure on Anthem in negotiations, Mueller said.

“It was more complex than a normal negotiation, primarily based on the geography and recent merger announcement by Advocate and Aurora,” Mueller said.

The new agreement between Froedtert South and Anthem is retroactive to Jan. 1, meaning care received by Anthem members at Froedtert South since the first of the year will be covered at in-network benefit levels.

“Our members remained our number one priority as we worked towards a fair agreement that’s in their best interests,” Nobile said in a press release. “We’re pleased our members in southeast Wisconsin will continue to have Froedtert South as a choice within our network of high quality, affordable health care providers.”

The agreement provides provides Anthem members in-network access to services at Kenosha Medical Center, St. Catherine’s Medical Center and all Froedtert South Medical Group clinics and affiliated physicians throughout southeast Wisconsin and northern Illinois.

“This new agreement will provide our patients with a continued continuity of care combining excellent regional medical center care at a local level and the highest of tertiary and quaternary care with our partner Froedtert & the Medical College of Wisconsin,” said Ric Schmidt, president and CEO of Froedtert South, in a press release.

Milwaukee-based health care providers have expanded their footprint in Kenosha County recently. As of October, the Froedtert Health brand officially entered Kenosha, when United Hospital System changed its name to Froedtert South under an expanded affiliation between the two systems.

Under that agreement, Kenosha Medical Center and St. Catherine’s Medical Center campus in Pleasant Prairie are now part of the Froedtert & the Medical College of Wisconsin health network. Froedtert South serves approximately 65 percent of the patient population receiving care within Kenosha County, according to a news release.

Aurora continues to expand its presence in Kenosha with a new 200,000-square-foot development project on 158 acres between 60th and 71st streets in Kenosha. Aurora has been in Kenosha since 1995, when it opened an outpatient health center, which was later expanded into a full service hospital, Aurora Medical Center Kenosha.

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