By Ronald Brandenburg
It’s no secret that positive relationships with health insurance companies are essential to the well-being of health systems. At Holy Cross Health, our ability to provide high-quality and affordable care to those who need it most across Broward County relies on the collaboration and cooperation of our industry partners—the insurance companies, or payors, who reimburse us for the patient care we deliver.
However, an inevitable game of tug-of-war is played when market pressures on providers become unsustainable. As a result, both parties commonly enter negotiations to modify contracts and business agreements that may no longer be viable. Time and time again, providers are offered negligible increases or even met with unsustainable reductions in compensation that jeopardize our ability to provide the high-quality, essential services that patients deserve and expect.
And while we try everything to avoid it, far too often, patients suffer immensely when negotiations go awry and cause undesired disruption. Across our nation, participation in employer-sponsored health plans remains significant, with approximately 157 million covered lives according to Kaiser Family Foundation in 2020. This health insurance benefit employers provide can swiftly depreciate as the cost of premiums rise while the volume of quality care providers considered “in-network” shrinks. What’s more, any purposeful initiative between the health system and employer to identify areas for cost savings, employee utilization, or benefits education is wasted when the provider and payor cannot reach a mutually agreeable arrangement. The patient no longer has affordable access to trusted primary care providers or specialists. The provider loses revenue that jeopardizes business operations. The health plan fails providers but maintains premiums.
Collaboration is essential for the sake of ensuring access to exceptional care and improving the health of the communities we humbly serve. Holy Cross Health knows this tug-of-war all too well as a not-for-profit health system, but without support from payors, both Holy Cross and our community suffer. We invest wholeheartedly back into the community for every dollar we earn by obtaining new technologies to improve healthcare services, upgrading facilities and ensuring our doors remain open to everyone – regardless of their ability to pay. We pride ourselves on these values because we know they are the foundation of all we do. Still, resistance exists.
The list of daily and ongoing challenges health systems across the country face is tiring and includes inflation, staffing shortages, continued treatment for COVID-19 patients and investments in the safety of our staff members who provide this care daily. Firm resistance at the negotiating table from our industry peers only increases the economic strain so many of us are facing today, inevitably putting patients and employers at risk of disruption in their care.
We are humbled that we have been able to serve our community with high-quality care for over 60 years, and we work every day to strengthen our relationship with payors who help us keep our doors open. I hope that negotiations will no longer be viewed as a tug-of-war between two “goliaths” because this perspective removes what matters – the patient. At Holy Cross Health, we firmly believe that everyone deserves access to the healthcare they know and trust to deliver compassionate care services. We remain committed to working toward a better tomorrow, as should every health system, including a collaborative relationship between the parties who provide and reimburse healthcare.
Ronald Brandenburg is Vice President and Chief Financial Officer, Holy Cross Health.
