Envision Healthcare rakes in up to one-quarter—or $1 billion—of its annual commercial revenue from UnitedHealth Group alone, the physician services provider's CEO told Modern Healthcare Tuesday.
That dynamic puts pressure on Envision to retain its in-network status with the health insurance giant in 2019 and beyond, especially as it finalizes its acquisition by the private equity firm Kohlberg Kravis Roberts, an event Envision's CEO, Chris Holden, described as "imminent." UnitedHealth last week warned more than 700 hospitals that Envision will likely be out of network starting Jan. 1, but Holden said the company intends to remain in network.
"At the end of the day, I believe it's going to be a win-win and it's going to work out," he said.
The two companies have sparred for months both in and out of court in a battle that mirrors countless contract disputes between payers and providers. UnitedHealth says Envision is charging too much for services, while Envision argues UnitedHealth is trying to shift more of the payment burden onto their members. They're currently in arbitration over their existing contract, and negotiating the terms of a contract that would begin in 2019.
Bob Kneeley, Envision's senior vice president of government affairs and investor relations, said when Envision initially became part of UnitedHealth's network, it did not affect the company's revenue. It's not clear what effect going out of network would have on Envision's revenue, he said.
Today, 91% of Envision's revenue comes from in-network providers, and the company's goal is to bump that to 95% by year-end, Holden said.
"We'd love to get to 100% but there is always going to be some subset of whether the payers don't want to do it or there are ongoing disputes or whatever is underlying that," he said.
Holden said the underlying issue is who shoulders the financial burden for the safety net system, including Medicaid and uncompensated care. It's a battle that's gone on for years, he said.
"If the payers want to engage, great," He said. "If they don't, we'll find another way, because it's driving people crazy. It's the thing that needs to be fixed. And pushing $1 billion out of network doesn't seem to be the right answer."
Envision is on track to finalize its acquisition by KKR in the coming weeks, Holden said. The company also passed KKR's extensive due diligence process, which featured a deep dive into Envision's prices, he said.
A KKR spokeswoman did not return a request for comment on whether the UnitedHealth spat was causing the company to second guess its pending purchase.
Holden also defended the company against the criticism that its prices are too high. On average, he said the company negotiates for 2% to 4% annual price increases, including with UnitedHealth. For the 2019 contract, however, Envision is not asking for rate increases, he said.
But UnitedHealth spokesman Stephen Shivinsky wrote in an email that as Envision adds more doctors to its ranks through acquisitions, it raises prices beyond market averages. Envision currently charges more than twice the average cost of other emergency department physicians in the carrier's network.
Holden said Envision takes in between $800 million and $1 billion in revenue from UnitedHealth annually, a significant portion of its roughly $4 billion in annual commercial revenue. The company's total annual is about $7.8 billion.
Shivinsky said UnitedHealth can't comment on how much it pays Envision, but said the company has offered Envision competitive rates that are similar to what other hospital-based physicians are paid in their respective markets.
"We remain committed to working with Envision in an effort to ensure its continued participation in our network by agreeing to a new business relationship that will help protect patients, employers and hospitals," Shivinsky said.
Holden declined to name other commercial carriers Envision is currently out-of-network with, but said the company has a pathway to get them in network by the year's end.