Duke Health, Aetna reach agreement to keep members in-network
Duke Health, the non-profit healthcare system that includes the Duke University School of Medicine, has reached an agreement with Aetna to stay in-network, just before the contract between the two was set to expire on Oct. 20.
With 1.5 million people in North Carolina covered by Aetna, an end to the dispute comes as a relief to patients in the state. The new agreement covers all Duke clinics and hospitals, including primary, specialty and emergency care.
According to a report from local news WRAL News, the heart of the conflict was care costs and reimbursement. Duke Health believed Aetna was not paying out enough for claims to match the inflating cost of care delivery. Aetna maintained that it was already reimbursing care to Duke at above the market rate, citing the especially high costs of care in North Carolina.
The issue seems to be resolved. However, the outlet noted, the actual details of the new agreement—including what concessions were made by either side—were kept confidential and not included in any public statement.
Notably, Aetna manages some 750,000 Medicaid and subsidized health plans in North Carolina. In a statement, State treasurer Brad Briner revealed that, if Duke had received the payment increases it was requesting, premiums for patients covered by the State Health Plan would have to be raised.
“We appreciate the steps Duke has taken to keep costs down for the Plan,” he said in a statement. “We have worked hard to dig ourselves out of a massive deficit and needed the help from all providers in the state to get that done. This deal represents Duke’s commitment to serve North Carolina and our members.”
Leading up to the settlement, Briner had been publicly critical of Duke’s position. He argued that it threatened to raise hospital costs all over the state.
More than 22,000 Aetna members use Duke as their primary care provider, and some 40,000 total utilize its clinics or hospitals each year.
“Throughout this negotiation, we have remained committed to serving our patients and their families’ best interests,” the health system said in its own statement. “We sincerely thank you, our patients and community, for your support in advocating to keep Duke Health in-network. Your efforts have made this positive outcome possible, ensuring you continue to have access to Duke Health experts and the high-quality care you deserve.”
The new contract sets terms for multiple years, though the exact timetable was not revealed.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.