A mutual agreement could not be reached by the contract deadline. The follow information is an insight into the reasons why.
Recently the OU Physicians administration has shared misleading information about Blue Cross and Blue Shield of Oklahoma (BCBSOK), creating fear and worry for our members. We’d like to set the record straight and give you the facts.
We want to be clear, BCBSOK’s negotiation is with OU Physicians administration and the out-of-state consultant they’ve hired, not with the nearly 1,200 individual doctors and health care professionals who give care to our members.
1. Myth: OU Physicians says the existing contract payments are not sustainable.
Fact: BCBSOK pays OU Physicians fair prices based on the value of services delivered, as we have done since their inception in 1991. Now, during a global pandemic, OU Physicians is demanding an excessive increase well above the current reimbursement rate, without any additional access to care for our members. OU Physicians has not offered any extra services or improved outcomes with their demand for more money.
2. Myth: OU Physicians says BCBSOK has not been willing to provide parity to the state’s most specialized group of research physicians, compared to what it pays other groups in other states.
Fact: We pay OU Physicians, and all our in-network medical professionals, fair market prices based on the value of their services. As a health insurer, we do not interfere with OU Physicians’ ability to attract and retain specialized groups of research physicians.
3. Myth: OU Physicians says they continue to make large investments in technology and care delivery and expect BCBSOK to pay their fair share of investments, like the $213 million, 5-year agreement with Epic software.
Fact: As stewards of our members’ health care dollars, we cannot, in good conscience, allow OU Physicians to fund their investments on the backs of BCBSOK members, which will raise rates and increase out-of-pocket costs. This is our members’ money and OU Physicians wants them to pay more.
4. Myth: OU Physicians says BCBSOK is undervaluing OU Health Physicians by paying them far less than other research-based physician groups across the country
Fact: BCBSOK reimburses providers based on the cost of delivering care in Oklahoma, not what the rates are nationally, including the east and west coasts. Oklahoma’s cost-of-living index is considered one of the lowest in the United States, per the National Cost of Living index. The rates we negotiate must be appropriate and align with the cost of living in our state. After all, it’s the people of Oklahoma who seek care from OU Physicians.
5. Myth: OU Physicians says BCBSOK is undervaluing OU Health Physicians, cutting into their investment to train physicians during a physician shortage where Oklahoma needs more access to doctors.
Fact: It is not the role of a health insurer to fund ongoing physician training at an academic hospital. Our role is to provide our members access to quality, affordable health care.
BCSBOK acknowledges the physician shortage in Oklahoma and because we are committed to providing our members access to care now and in the future, we’ve partnered with the State of Oklahoma and the Physician Manpower Training Commission (PMTC) to support the Physician Loan Repayment program. The PMTC grant program invests in reimbursing health care students for a portion of their education loans, in exchange for working or practicing in rural and underserved parts of the state.
6. Myth: OU Physicians says they need YOUR health care dollars to invest in research.
Fact: As academic research physicians, OU Physicians has their research and technology investments paid through federal and private grants. According to the OU Medicine magazine published Fall/Winter 2020, OU Health Sciences Center “earned a record high $190 million in federal and state awards during state fiscal year 2020.” They further state their federal funds increased by 43% over the previous fiscal year. BCBSOK members buy health insurance for peace of mind, to pay for their medical care and protect them from overwhelming health care costs, not to fund research projects.
Our members should not be expected to pay for research and technology investments when health insurance is designed to pay for the delivery of medical and surgical care, as well as prescription drug expenses incurred by the person insured. While research may ultimately benefit all OU Physicians’ patients, it is not BCBSOK’s role as a health insurer to fund research.
7. Myth: OU Physicians says they are committed to ongoing discussions.
Fact: OU Physicians has hired a third party, out-of-state consultant to negotiate their agreement in an effort to gain exorbitant rate increases from our members. This is out of touch with what Oklahomans can support, especially during the pandemic. The consultant is driving up health care costs in our state that will impact all Oklahomans.
8. Myth: OU Physicians says BCBSOK is taking their record windfall profits from an unprecedented and deadly pandemic and shipping it out-of-state to their corporate headquarters.
Fact: BCBSOK is a member-owned company and does not pay dividends or answer to shareholders. BCBSOK re-invests profits to develop products and services for members in our state.
We have deep roots and long-standing relationships in Oklahoma. Our 1,100 employees live and serve in our communities. We are part of a larger organization that shares knowledge and support that helps Oklahomans.
BCBSOK invests in local communities through programs like The Oklahoma Caring Foundation, a 501(c)3 nonprofit organization that supports programs that gives Oklahomans access to preventive health services. We administer these services through the Foundation, which also operates The Oklahoma Caring Van Program, providing immunizations for children at no cost to their families.
In 2020 alone, we spent more than $100 million directly in Oklahoma on COVID-19 relief, without the support of funds from the Coronavirus Aid, Relief, and Economic Security (CARES) Act. In addition, we provided $20 million in premium credits to fully-insured employer customers. Most of this was done for our members and Oklahomans because it was the right thing to do, not to fulfill a government requirement.
9. Myth: OU Physicians says BCBSOK is using its market power to harm Oklahomans by driving health care dollars out of state and forcing our citizens to have to travel hundreds of miles to find in-network specialty care.
Fact: Our members have access to one of the largest and most robust health care networks in the state, with coverage in all 77 Oklahoma counties. Our networks consist of approximately 98% of Oklahoma’s practicing health care workers, which involves thousands of primary care physicians and specialists. We also have a program called BlueCard℠ that gives our PPO members the flexibility to seek in-network care nation-wide, should they choose to do so.
10. Myth: OU Physicians says you called us heroes, but BCBSOK is undervaluing our role in Oklahoma healthcare.
Fact: BCBSOK appreciates and acknowledges the dedication of all the health care heroes who have given care to our members throughout the COVID-19 pandemic. As Oklahomans, our gratitude extends to OU Physicians, along with all the health care workers across the state, fighting a global pandemic.
BCBSOK also appreciates the front-line heroes who don’t wear scrubs, such as essential employees like first responders, teachers, grocery and convenience store workers, law enforcement and non-profit workers, just to name a few. Many of these heroes are also our members.
As the state’s largest member and customer-owned health insurer, we have a responsibility to stand with our members and be good stewards of their health care dollars. We manage their dollars by negotiating fair and reasonable rates for all parties, which ensures financial stability and peace of mind for all our members.
The Bottom Line: Despite OU Physicians’ attempts to raise our members’ health care costs, we will always protect our members and be good stewards of their health care dollars.