JCMG, Anthem reach new agreement

The exterior of the new Jefferson City Medical Group Outpatient Surgery Center. (Ethan Weston/News Tribune photo)

Jefferson City Medical Group and Anthem Blue Cross Blue Shield reached an agreement on reimbursement rates late Tuesday night.

The agreement means the medical group will stay in the insurance company’s network. The new contract will last through the end of 2026, spokesperson Emily Snooks of Anthem Missouri stated in an email.

“This new value-based care agreement is designed to improve the quality of care delivered while protecting affordability for Anthem members,” Snooks added.

This reimbursement system is different from a fee-for-service model, according to a Q&A article from the website of Elevance Health, Anthem’s parent company. The new contract will reimburse the medical group based on outcomes rather than the number of individual procedures or services carried out by the provider.

The value-based model ties payment to health care staff to the latter’s ability to provide personalized, coordinated treatment, according to the Q&A. Quality health care services in this sense include providing preventive health care measures such as annual exams and recommended screenings.

With the signed contract, JCMG will remain in-network for its approximately 30,000 patients with Anthem health plans, according to a JCMG news release.

“This multi-year contract has helped ensure JCMG’s sustainability as an independent healthcare provider for our patients and community,” Ilana Holland, the director of marketing and communications at JCMG, stated in an email.

The two organizations faced a midnight deadline before JCMG fell out of the Anthem network. On Friday, Anthem invited leadership from JCMG to meet Monday. But, by very late Friday night, the health care provider had not responded, according to Snooks.

It was not clear whether the sides came together Monday or Tuesday, but late Tuesday, JCMG announced it had reached a “mutually acceptable agreement.”

Although the agreement on the rates is to last through 2026, the previous contract also had an agreed-to duration.

The sides signed a contract in 2022 outlining reimbursement rates Anthem would pay for care at JCMG. That three-year agreement was to continue through 2024.

The contract gave JCMG the right to renegotiate reimbursement rates with a 90-day notice. The two organizations entered contract negotiations Aug. 8. It is unclear whether the latest agreement has a similar clause.

Following the announcement that JCMG was exercising its right to renegotiate the contract, discussions became contentious, with Anthem stating the rate increases JCMG requested were six times the rate of inflation. The insurer also characterized the decision the medical group took to renegotiate reimbursement rates as not standard.

JCMG countered that the insurance company only increased reimbursement rate by 14 percent since 2015, when inflation during that period has risen around 30 percent. The provider also argued its low reimbursement rates prevented it from recruiting and retaining great health care providers.

After signing this new agreement, the medical group is in a position to recruit and retain employees who can provide cost-effective quality health care services, Holland said.

“JCMG’s strengthened partnership with Anthem has helped stabilize independent healthcare access in Mid-Missouri,” she stated.