As a valued and loyal partner in our mission to provide access to high quality, affordable health care, we want to make you aware of provider contracting discussions that have been made public in Central New York.
While this doesn’t impact all our brokers and groups, it does present an opportunity to educate and provide background information on this topic. Health care is facing numerous challenges, and this situation illustrates the tone and complexity our industry is enduring around costs, access to care, and more. Some providers are using public pressure as a negotiation tactic. You may hear about these discussions more often, which is why we’re sending this communication to all brokers.
Our priority is to ensure that the providers your employers and members trust remain within our strong network, which includes 98 percent of local providers.
FamilyCare Medical Group In Central New York
FamilyCare Medical Group (FCMG) is a Syracuse-area physician group with 28 locations covering Onondaga, Cayuga, Cortland, and Oswego counties. On May 16, 2024, they notified us of their decision to terminate their participation agreement with Excellus BCBS effective December 31, 2024.
We have been and continue to be in active contract discussions with FCMG. They assured us that the termination notice issued was a step to engage Excellus BlueCross BlueShield in discussions regarding a Medicare risk-based agreement. FCMG also has told us that it fully intends to go forward in a new contract with Excellus BCBS.
Naturally, we were disappointed to learn that they sent a letter to members stating that they will no longer be part of our network effective January 1, 2025, if a mutually acceptable agreement is not reached. FCMG’s termination would be effective across all lines of business (Commercial, Medicare, Medicaid) and affect all forms of group and individual health plans.
What You Can Do
- Let your groups and members know that these types of contract discussions are typical for this time of year, and in almost every case, they end successfully. We still have five months to come to an agreement.
- Help us educate your groups and members about what these contract discussions are typically about when they go public. Some providers during contract discussions may ask for more money. We work hard to support our doctors and hospitals. They’re dealing with rising health care costs, just like your groups are. We often turn down large rate increase requests because we’re prioritizing the affordability of our members’ care. If we pay providers a lot more money, premium rates for your members and employers could go up.
- Tell your groups, that at this time, there is no action required by our members. They can continue to access services with FCMG as they normally would.
What We Are Doing
- Excellus BCBS will continue discussions with FCMG in the hope of continuing our relationship of more than 23 years. We remain confident that we will have a mutually agreed upon contract by the December 31, 2024, deadline.
- We are working on a communication to our members in Central New York, Utica and Southern Tier regions that will provide education on provider contracting discussions in general. See the Member Letter (PDF) attached.
- We’re preparing disruption reports for you and your clients (CNY ONLY) to better understand the impact this situation presents to your groups and their employees.
We are grateful to have you as an extension of our business and our mission. Please reach out to your account representative with any questions you have or any information or concerns you would like to share with us regarding provider contracting.
Thank you for being a trusted partner.
