CDPHP, NYOH Resolve Contract Dispute

Jan 27, 2015

Health insurer Capital District Physicians Health Plan and the area's largest cancer care provider New York Oncology Hematology announced Monday they've settled their differences and will continue working with each other.  The accord means cancer patients undergoing treatment plans are no longer caught in the middle.

The relationship between the two entities was in jeopardy when CDPHP requested cuts that NYOH claimed would have affected care for about 2,500 local cancer patients — many of whom suddenly found themselves unsure of how to pay for continuing care.  CDPHP spokesperson Ali Skinner says round the clock talks were held to come to a resolution that was in everyone's best interest.    "We've been telling our members to kind of hold tight. We firmly expected that we would reach an agreement with NYOH and that's exactly what happened. We're relieved, we think our members are relieved, and NYOH is as well."

NYOH board president Dr. Nini Wu says patients come first.    "This was really about ensuring that we have the resources to provide the care that we feel most appropriate for them that they need and deserve.  I can't express how pleased I am that I was able to work forward together with CDPHP and that we can reassure patients that their treatment will continue. This is what the focus needs to be on. “

Word came in December that the two sides were at an impasse over a contract due to expire February 2. Neither side is revealing the particulars of the agreement.   "We came to an agreement based on a great deal of meeting and working hard to educate each other. In our case about the complexity of the cancer care, our processes and policies, and we were able to find common ground so that they could understand that this is really about the total cost of providing high quality cancer care. This wasn't about the drug, as much as about the ability to ensure that patients could see the nurses, the technology, and have the convenience of being close to home."

If an agreement hadn't been reached, patients would have had to find new providers by early March. Skinner sees continuing the partnership as a win-win-win:   "Originally the contract dispute was over a commission incentive that CDPHP pays oncologists for the cost of injectable drugs. We were simply proposing to reduce that commission that they make above and beyond the cost of the cancer drugs. While we can't get into the details of the contract that we were able to agree to, what we can say, is that we were able to improve efficiencies for the costs and access of care for our members."

The agreement terminates a class-action lawsuit that had been filed on behalf of NYOH patients who were CDPHP members.

Patients with further questions are asked to contact a representative at the number on their ID card.