Northland residents singing the healthcare ‘Blues’

A contract issue between a massive insurance company and a relatively small network of independent physicians and clinics in Minnesota could have a fairly dramatic impact on thousands of Northland residents.

3018838+120816.N.PJ_.HEALTHCAREBLUES Raiter clinic cmyk .jpg

A contract issue between a massive insurance company and a relatively small network of independent physicians and clinics in Minnesota could have a fairly dramatic impact on thousands of Northland residents.

In Carlton County alone, the decision by Blue Cross Blue Shield of Minnesota to not negotiate with Integrity Health Network could mean local patients of Raiter Clinic and Human Development Center in Cloquet and Cromwell Medical Clinic will have to find new doctors or pay extra for services. That’s because anyone insured by BCBS - although not those on the BCBS Senior Gold Plan - will be out of network as of Feb. 1 if the two sides can’t reach an agreement.

It’s not a small number. In Cloquet and the surrounding area, the number of people insured by BCBS is significant, and includes workers (and their family members) at Sappi, the city of Cloquet, Carlton County and more. The above-named local clinics also will not be considered “participating clinics” for people covered by other Blue Cross Blue Shield companies, such as BCBS of North Dakota, as well. And, while the Senior Gold Plan members will still be covered locally, Medicare clients on the Platinum Blue Plan won’t be, according to Starr Marshall, an insurance agent with Reliable Insurance in Cloquet who said she’s been working until late nearly every night trying to help the large number of Medicare clients who also have BCBS coverage through Reliable.

This is no ordinary contract squabble. On the one side sits BCBS, Minnesota’s largest insurer. On the other side sits Integrity, a network of more than 200 doctors and providers in 47 clinics and facilities in 23 different communities. These are independent providers who joined together so they could have the same kind of negotiating power as clinics owned by healthcare groups such as Essentia Health or Mayo Clinic Health Systems.

A spokesperson for BCBS said in its only statement to the Pine Journal that the company wants to “secure separate and customized agreements with all of the individual doctors and clinics currently represented by Integrity Health Network” and that continuing to negotiate rates “through a third party is not in the best interest of its members.”


However, Raiter Clinic’s Dr. Ken Ripp points out that time spent by doctors negotiating is time spent away from patients in a rural area already suffering from a shortage of physicians.

“We can spend our time doctoring now, and that infrastructure [provided by Integrity] allows us to get good contracts and do total ‘cost of care,’” he said, referring to a contract method in which doctors, hospitals and insurers in a geographic area partner together to improve care while bringing costs down through coordinated care. “So we work collaboratively with the insurance companies, all of them.”

While Raiter Clinic - which has 10 family practice doctors, two nurse practitioners and 15 specialists/surgeons affiliated with the clinic, according to its website - might be able to manage hiring a highly trained staff member to handle negotiations instead of Integrity, what could smaller members do, he asked.

“How is Shawn Bode, a doctor of one, going to negotiate a contract with the Blues?” said Ripp.

Dr. Bode, owner and sole family practice physician at Cromwell Medical, said negotiating individually with giant insurance companies is not a viable option for him.

“Being part of Integrity is huge for a small clinic like ours,” Bode said, explaining that he and his staff members can focus on patient care while Integrity helps the small clinic coordinate quality assurance, keeps them up to date on the latest government stipulations, does their contracting and more. He added that being part of the network also gives Integrity members the numbers to be able to qualify for discounts in things like purchasing and malpractice insurance.

“Simply put, we could not have a viable clinic without Integrity,” Bode said. “That is why it is important for us not to allow BCBS to break up the Integrity Health Network. In today's world of mega clinic and hospital systems, small clinics like ours couldn't survive without forming some type of partnership. Yet, I believe it is small clinics like ours that give that special, personalized care that yields the highest quality.”

Integrity President Jeffrey Tucker explained what IHN does is “harness economies of scale,” for everything from purchasing medical equipment/supplies to contract negotiations to qualifying for federally run healthcare programs that require a certain minimum number of patients.


In addition, Integrity offers shared resources for its members, with expertise in the following areas, Tucker said:

  • Mandated government and health plan reporting;

  • Medical staff training and professional development;

  • Risk management and clinic operations/cost reduction; and

  • Quality improvement and pay for performance development, administration, training and reporting.

“We were created because it doesn’t make sense for every single clinic to duplicate what we do, like create a quality improvement program for example, when they can do it under our umbrella,” said Tucker, who lives in Carlton and works at the Integrity office in Duluth.
After Integrity went public with the BCBS dispute in a press conference in Duluth Nov. 15, BCBS sent letters to at least some Integrity member clinics requesting they sign the contract by Dec. 15, or the insurance company would begin removal of the clinics from its network and begin sending patient notification letters.

Bode estimated about a third of the Cromwell clinic’s patients carried BCBS in 2016. He is frustrated because BCBS picked a date of Feb. 1, 2017, to drop the contract, so the insurance company’s website is listing the Integrity clinics as being the “in network” provider because the list starts on Jan. 1. That has caused some confusion for his patients, but he’s been working with them to explain what could happen.

“Most patients who could choose their own insurance have switched to another carrier for 2017,” Bode said. “The ones left will be those whose employers or unions carry BCBS, still probably 20 percent. Many of these patients, though, have expressed their feelings to their employers and unions. Though many may not have time to change for 2017, some of these employers and unions may switch their insurance carriers for 2018. We will see.”

On Monday, Tucker said some of the Integrity officials are meeting with Gov. Mark Dayton and state legislators this week in the hopes that they can persuade BCBS to negotiate.


Carlton County and its employees recently decided to continue with Blue Cross Blue Shield of Minnesota as the county’s health insurance carrier for 2017 after considering a switch to Health Partners, although news that the local clinics might not be included “in network” caused additional concern for county officials and employees.

County Coordinator Dennis Genereau spoke with officials from BCBS and Integrity and said the situation feels like “union busting” to him. He pointed out that Integrity is not a large umbrella organization. It has a total of five employees, two are part-time. They work for the Integrity board, which is made up of doctors who are also Integrity members.


“I can’t speak for the county, I’m not the voice of the county,” Genereau clarified, adding that the county is already forming an insurance company to prepare for next year’s negotiations. “But the general sense I got was a lot of frustration from employees that Blue Cross was threatening this Integrity Health Network’s way of doing business, and was jeopardizing the benefits that come to the employees through the IHN doctors in that, if they don’t sign that contract then they’re out of network and if they’re out of network, you’re going to to have to pay a whole lot more. I can tell you personally, that I did not like it.”

His frustration was echoed in other places around Carlton County.

City Administrator Brian Fritsinger is concerned about the possibility that the city’s employees won’t be able to use Raiter Clinic as part of their network of doctors. Fritsinger noted that Raiter Clinic is a major employer of the city and provides significant public health benefits to the residents.

“There is no question that the loss of local BCBS relationships within the community and region will result in increased costs to our employees, the city and our residents,” Fritsinger said. “Even little things such as the loss of productivity when an employee needs to travel for health care versus being able to simply make a quick run to the local clinic will have an impact on our service delivery through the resulting use of increased sick leave.”

Insurance agent Starr Marshall said clients on the BCBS Platinum Blue plan will either need to find another clinic and new doctors if the local clinics are dropped, or they could use just Medicare when they visit the local clinics, which would leave them with a 20 percent co-pay. They could also change to a different insurance company.

“People are really concerned, they stop me on the street to ask about it,” Marshall said, stressing again that the Senior Gold Plan members don’t need to worry. “So am I. We have a large Medicare base here at Reliable and I just want my seniors to be OK. Some of them have had the same doctors and clinics for 30 years.”

BCBS members have another option. They can file a grievance with the insurance company by simply calling the member services number on the back of their insurance card and asking to file a grievance regarding the company’s intent to drop local clinics which don’t agree to negotiate independently with BCBS.

In the meantime, the Dec. 15 “soft” deadline rapidly approaches.

“We hope common sense will prevail and an agreement reached between all parties,” Fritsinger said.



In the Northland, Integrity members affected by the BCBS contract dispute include the following:

In Carlton County:

Raiter Clinic of Cloquet

Human Development Center

Cromwell Medical Clinic

In Duluth

Duluth Kidney Services

Fall General Surgery

Human Development Center

Laboratory Medicine Specialists of Duluth

Northland Ear, Nose and Throat Associates

Northland Gastroenterology, PA

Northland Neurology and Myology, PA

Northland Plastic Surgery

Orthopaedic Associates of Duluth, PA

Radiological Associates of Duluth, PA,

Relf EyeCare Specialists, PA

In Hermantown

Orthopaedic Associates Physical and Occupational Therapy

About the rest

The Iron Range Clinic in Eveleth and Itasca Surgical Clinic in Grand Rapids are also Integrity members.

Although they are affiliate members of Integrity, Mercy Hospital and Healthcare Center in Moose Lake would not be affected.

Essentia Health and St. Luke’s hospitals in Duluth are not Integrity members.

Related Topics: CARLTON COUNTY
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