LPSS reports progress on network disruption after switch to Meritain/Aetna and Verity; 86-provider disruption list being negotiated

Tony Murray of Gallagher presented the district's monthly benefits monitoring and introduced later speakers who briefed the board on provider disruptions resulting from the district's move from Blue Cross to Meritain (Aetna) with a Verity network wrap.

Kelly Cox, the independent consultant leading outreach, said the project began with 86 providers on a disruption list — 4 later identified as closed or retired, leaving about 82 — who were in Blue Cross but not in Aetna or Verity. Cox described a three-tiered approach: direct contracting with providers willing to negotiate a standalone agreement; network contracting through Verity or Aetna; and targeted outreach where providers might decline participation. "When we first started to tackle this project, there were 86 providers on the list who were contracted with Blue Cross but were with neither Aetna or Verity," Cox said.

Alex Grama, vice president of business development for Verity, provided a line-by-line status for that list: of the roughly 82 active entries, Verity had 29 executed contracts, 18 providers who had agreed to join but were still negotiating fee schedules, 11 providers who had been contacted with no response, 4 closed or retiring providers, and 12 who had declined direct contracting. Verity staff and the district said outreach would continue and that the list is a living document.

Cox and other presenters emphasized that some sole practitioners or small providers decline network participation for operational reasons even if they previously participated with Blue Cross. The presenters noted that a subset — reported in the meeting as about 22 providers — declined to work with the district under the new arrangements or only work exclusively with Blue Cross, and that member pressure sometimes changes a provider's stance. "No voice is louder than that coming from their own customer or patient," Cox told the board.

The district reported one successful direct contract: Acadian Ambulance. The superintendent and presenters described Meritain's proposal as financially favorable compared with the prior Blue Cross arrangement and said Meritain permitted direct contracting and other strategies the district used to lower net costs and secure access. "The reason that we went with Meritain over anyone else was because of their proposal based on the exact claims that had been processed the previous year," the superintendent said.

Practical steps for members were reviewed. Staff said members would be able to search provider participation with the new networks via an online search tool and that the district planned a direct communication to members about the list. Trish (district staff) said the Verity search portal auto-populates executed agreements; staff set a target of Dec. 15 to update the public-facing lists and urged members to verify in advance of Jan. 1 plan effective date. "Everyone is gonna have health coverage on January 1," a district official said. "What we're trying to do is we're trying to get ahead of that provider that hasn't switched over in our network."

Board members asked whether the district will proactively notify members whose providers remain out of network and how quickly pending agreements will be executed; staff said notifications and search tools are available and that executed agreements will be reflected in the search portals once effective dates are reached, but that some negotiated agreements may not finalize until after Jan. 1. The presenters said the outreach will continue after implementation and that members concerned about a provider should ask that provider to contract with the district's networks.

No formal vote occurred; presenters described recordkeeping, outreach, and contract execution as ongoing work the district and networks will continue after the meeting.