Unresolved Contract Negotiations Leave Sonoma County HMO Members Uncertain of Options
About 32,000 HMO members in Sonoma County are in "limbo" and do not know yet whether their health plan will sign contracts with physician groups before the agreements expire on Dec. 31, the Santa Rosa Press-Democrat reports. The majority of unsigned contracts for next year involve Health Plan of the Redwoods and doctors represented by St. Joseph Health Foundation, Primary Care Associates and Valley of the Moon Medical Group. Redwood Regional Medical Group, which has three dozen radiologists and oncologists, is also one of several specialty physician groups that remain in negotiations, which have mostly centered around the level of reimbursement rates from health plans. In addition, St. Joseph Health Foundation is seeking a fee-for-service contract instead of capitation payments, which has added an "element of instability" to the ongoing negotiations. Patients with doctors associated with St. Joseph and Primary Care Associates have additional uncertainty because the medical groups in July stopped acting as the "financial intermediary" between health plans and doctors at Memorial and Petaluma Valley hospitals.
Despite the delay in contract agreements, most HPR members are guaranteed coverage next year because of an agreement with Sutter Medical Group of the Redwoods, which is the largest medical group in the county. Still, contract decisions through the end of the month "are crucial because thousands of employees" are preparing to choose a plan offered by their employer, the Press-Democrat reports, adding that Dec. 1 is typically thought of as the 30-day advance-notice deadline for health plans to inform members of potential disruptions in patient care. But Dr. Jose Arevalo, HPR's vice president for medical services, said, "We continue receiving new physician contracts every day, so a list we issue today will be incomplete by tomorrow. The bottom line is we want to assure our members we'll have a panel in place by Jan. 1, 2002, that will meet their medical needs" (Rose, Santa Rosa Press-Democrat, 11/18).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.