As you may have heard, CDPHP is currently in discussions with Albany Med Health System (AMHS) regarding two separate issues.
2025 Contract
CDPHP and AMHS are negotiating in good faith with the goal of reaching a fair and equitable contract agreement that avoids any disruption in care for our members.
Unfortunately, AMHS has decided to take these negotiations public when both parties are committed to ongoing discussions. We find these actions unfortunate because they put you – the patients – in the middle of normal business discussions.
Though our contract termination date is December 31, a 60-day period where all members can continue to get care at AMHS facilities is required by regulation. If you are currently in an ongoing course of care, that period is extended for another 30 days. As this allows for several more weeks of negotiations between our organizations, there is no reason to worry about your care.
The Medicare Wage Index
While negotiations between hospitals and health plans are a normal part of business practices, our discussions are complicated by the fact that CDPHP and its competitors are facing financial hardship due to the Medicare wage index. This regulation granted hospitals in Upstate New York a windfall of $1 billion. Unfortunately, federal regulators failed to align private Medicare Advantage premiums with this adjustment, leaving CDPHP with a significant unfunded mandate that will result in nearly $145 million in losses over the next two years.
In the best interest of our members, particularly seniors on fixed incomes, CDPHP stopped paying this new, unfunded mandate in order to protect your benefits and out of pocket costs.
We do, however, continue to pay our hospital partners at the rates agreed to prior to this unfunded mandate. That means, your care is covered, and your claims are being paid.
We understand the critical nature of the services AMHS provides, and we are doing everything we can to retain them as part of our network.
Why is this happening?
Negotiations with hospitals and health plans are a normal part of our business practice. We use these discussions to advocate for you – our valued CDPHP members – to ensure you receive the highest quality of care at the most affordable price. It is unfortunate that AMHS has chosen to take these negotiations public, putting you in the middle.
What happens if an agreement is not reached?
CDPHP understands the value AMHS brings to our community, which is why we are working hard to reach an agreement and avoid any disruption in care for our members.
If we do not reach an agreement by December 31, 2024, members may continue to receive care at AMHS and its affiliates for an additional 60 days during what’s called the “cooling off” period through March 1, 2025. In addition, members who are in an ongoing course of care with an AMHS primary care physician or specialist may continue to receive care until March 31, 2025.
Members who are pregnant as of January 1, 2025, and seeing an AMHS doctor for pregnancy care can continue to see their provider until their baby is born and postpartum care is complete.
How do hospital costs affect me directly?
Today, 40 cents of every dollar you spend on health insurance goes directly to hospitals. As a good steward of your health care dollars, CDPHP feels strongly that it is our responsibility to advocate for lower hospital costs, which is why we are holding the line with AMHS.
Updated December 17, 2024
ALBANY, N.Y. – November 21, 2024 – CDPHP and Albany Med Health System (AMHS) are in active discussions regarding our contract renewal. Over the last several weeks, we believed the parties were negotiating in good faith with the goal of reaching a fair and equitable contract agreement that avoids any disruption in care for our members.
“Unfortunately, the leadership of Albany Med has decided to take these negotiations public when both parties had committed to ongoing discussions. In addition to numerous factual inaccuracies in their statement, the actions by the leadership of Albany Med are in direct violation of the confidentiality agreement the parties entered into no more than 10 days ago while trying to amicably resolve this dispute. Their statement today is nothing more than a blatant attempt by a large hospital system to bully CDPHP and unnecessarily alarm our members and their patients. As a not-for-profit, community-based health plan, our focus is to ensure that our members are provided high quality health care at an affordable price. We find these actions unfortunate because they put you – the patients – in the middle of normal business discussions. Their actions today are nothing more than a shameful attempt to bully the health plan and alarm and confuse our members who are their patients.” said CDPHP president and CEO, Brian O’Grady.
Contrary to their contention, there is no imminent crisis. Though our contract termination date is December 31, 2024, there is a state mandated 60-day “cooling off” period where all members can continue to receive care at AMHS facilities until March 1, 2025. In addition, if you are currently in an ongoing course of care, that period is extended for another 30 days. This period allows for several more weeks of negotiations between our organizations, therefore, there is no reason for members to worry.
The Medicare Wage Index
While negotiations between hospitals and health plans are a normal part of business practices, our discussions are complicated by the fact that CDPHP and its competitors are facing financial hardship due to the Medicare wage index. This regulation granted hospitals in Upstate New York a windfall of $1 billion. Unfortunately, federal regulators failed to align private Medicare Advantage premiums with this adjustment, leaving CDPHP with a significant unfunded mandate that will result in nearly $145 million in losses over the next two years. The issue is exacerbated by the fact that CDPHP has increased current and prior year commercial rates to supplement historically low Medicare rates.
CDPHP stopped paying this new, unfunded mandate in order to protect your benefits and out-of-pocket costs for members. CDPHP does continue to pay our hospital partners at the rates agreed to prior to this unfunded mandate. That means, your care is covered, and your claims are being paid.
CDPHP recognizes the tremendous value AMHS offers our community, and we are committed to reaching a fair and equitable agreement.
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About CDPHP®
Established in 1984, CDPHP is a physician-founded, member-focused and community-based not-for-profit health plan that offers high-quality affordable health insurance plans to members in 36 counties throughout New York. CDPHP is also on Facebook, X, LinkedIn, and Instagram.