Maryann Reese: While we cut prices, United used patients as pawns

Editor's note: The Southeast Missourian invited UnitedHealthcare and Saint Francis to share their perspectives on current negotiations. Here is Saint Francis' update.

After becoming president and Chief Executive Officer in the fall of 2017, many told me prices at Saint Francis Healthcare System were too high. We consulted with an independent company to perform a pricing study of Saint Francis compared to hospitals and health systems in St. Louis and the surrounding region. The results showed Saint Francis had work to do.

Even though our contracts with insurance companies allow for annual price increases, we voluntarily froze prices starting in 2017. In Jan. 2019, we decreased prices by 15%. In Jan. 2020, we decreased prices by another 10%. Our price freeze and those price reductions amount to more than $30 million in savings for all insurance companies and $10.5 million specifically for UnitedHealthcare.

In negotiations, I expected United to acknowledge our price reductions, and to extend the savings to our patients and employers. Instead, United increased premiums for employers and ignored our $10.5 million price cut. The price cut ended up in United's pocket whose profits totaled $9 billion for last quarter alone.

At the same time United was selling employers plans they said would include Saint Francis in-network, they were issuing Saint Francis a letter of termination. United terminated the contract while we were willing to continue negotiations. United even has a term for this tactic -- "Terminate to Negotiate." Using patients as pawns is the promise we believe was broken.

United wants $11.5 million cut from our prices. We have already cut $10.5 million. We did this before they asked. United needs to acknowledge the reductions already given. To provide an additional $11.5 million jeopardizes our ability to keep our doors open long-term.

In addition to price, Saint Francis is negotiating with United on tiering and steering of Saint Francis services. Tiering occurs when an employer decides to include Saint Francis in their insurance plan, but at a different level with higher premiums, deductibles and out-of-pocket expenses for employees. We say, "Saint Francis is now the high-quality, affordable option. Don't tier us."

Steering occurs during the pre-authorization process when an insurance company directs a patient away from services that are part of a physician's plan of care to a lower cost and, many times, lower quality option. We object. Steering patients toward lower quality care options can increase the cost of care as tests and procedures must be repeated because of poor quality. We propose that if United wants to steer the patient to a lower cost option, then the quality must be equal to or better than Saint Francis.

Saint Francis is negotiating with United on three points. The first is price stability. We want United to agree that Saint Francis is appropriately priced, and has met the requested price concessions. Second, do not tier Saint Francis, as this does not make sense with our exceptional quality and affordable price. Lastly, do not steer patients to providers with quality standards less than Saint Francis.

It is a privilege to lead the largest company in Southeast Missouri. Entrusted to me are more than 3,000 employees and their families' livelihoods. In addition, my responsibility as a health care CEO includes the health outcomes, experiences and costs of the communities we are called to serve. We set out on a multiyear journey to lower prices, and I am proud of the Saint Francis Family and our accomplishments.

We look forward to the good yet to be as we move forward in good faith negotiations with United. But, if an agreement cannot be reached, Saint Francis facilities will no longer be in-network with UnitedHealthcare beginning March 5, 2020.

Maryann Reese is president and chief executive officer of Saint Francis Healthcare System.