Effective October 13th, St. Mary’s Medical Facilities will no longer accept Prominence HMO plans. This affects Prominence Medicare Advantage HMO and commercial HMO plans. They won’t work with Saint Mary’s medical group, hospital, imaging and urgent care centers.
This past August Prominence HMO plans and Saint Mary’s Medical Center ended their contract. This is an extension of that termination. For today, Prominence commercial PPO plans and point of service plans are still accepted at St. Mary’s, but we expect that to change shortly.
Notices from Prominence Health Plans put the blame on Saint Mary’s and their parent company Prime Healthcare. From what we’ve observed, this is a combination of several factors.
Lack of a partnering health plan
Saint Mary’s Hospital is the only hospital in Northern Nevada not paired with their own medical plan. In the past they had Saint Mary’s Health Plans. Renown is under the same ownership as Hometown Health and Senior Care Plus. Northern Nevada Medical Center and the new Northern Nevada Sierra Medical Center are owned by the same company that owns Prominence. Saint Mary’s owned by Prime Healthcare. Prime does not have an active health plan in Northern Nevada for Medicare or small businesses today. This may be changing for 2022 with the introduction of the Medicare insurance companies Atrio and Allignment Healthcare. Saint Mary’s Health Plans has partnered with these two companies for Medicare.
Population Growth of Northern Nevada
It’s clear Northern Nevada has been growing in population. From what my office has seen, our local medical groups and providers offices are finally starting to catch up. New facilities are being built faster than we’ve ever seen. For at least the past 30 years we’ve had 2 major medical groups in town, Renown and St. Mary’s. What we’re seeing with the contract termination is the development of a very large 3rd medical group. More medical groups mean more competition, lower prices, more choices…. Yet we’ve also got our growing pains. Network changes like these are becoming more common.
The new Northern Nevada Sierra Medical Center Hospital
The parent company of Prominence Health Plans, UHS expects to complete the new hospital in March of 2022. It will be the newest facility in town and it has a lot of people talking. If a patient had the choice between using the oldest hospital in town or the newest hospital for a surgery, there may be some favoritism. There is some suggestion Saint Mary’s is trying to head this off before it gets to that point. They could do this by ending the contract now and introducing their own Saint Mary’s Health Plans. Regardless, both health plans have an excellent choice of doctors. We expect both to do well this Medicare Annual Enrollment Period.
Growth of Independent Medical Groups
New medical groups in town are starting to drum up competition and take away from the larger more established groups. Pinnacle Medical Group is a great example of that, along with Vera Health Clinics. These clinics have been popular among both doctors and patients. The idea is to be able to cut through the corporate red tape, deliver more patient centered care and lower wait times. They have their drawbacks, yet their increasing numbers speak for themselves.
This split was inevitable. This is a continuation of the split that has been happening for years. First Saint Mary’s Health Plans divorced themselves from Saint Mary’s hospital. Then changed their name to Prominence Health Plans. Universal Health Services bought them. Now with UHS building their own hospital, the contract with Saint Mary’s comes to an end.