Healthcare in a Minute: Excellus vs. WellNow

By George W. Chapman

While I have no specifics regarding the stalemate as of this writing, I can offer my considered observations. Basically, unless the stalemate is broken, all three parties — Excellus BlueCross BlueShield, WellNow, consumers — will lose.

First, Excellus.

The insurer controls virtually 85% of the market and faces little competition. Unless it can produce some urgent care alternatives, other plans will have a great selling point and may take members away from Excellus. Urgent care centers provide an invaluable and cost-effective service. They keep hundreds of same day acute care visits out of overbooked physician offices and overrun emergency rooms. Depending on the problem, urgent care allows some employees to get back to work the same day versus wasting the entire day in an ER.

Urgent care centers are paid far less than an emergency room for the same visit. It seems Excellus is shooting itself in the fiscal foot by excluding WellNow from its provider panel.

Second, WellNow.

Since Excellus controls so much of the commercial market, any provider (physician or hospital), would suffer financially if excluded by Excellus. WellNow provides an invaluable service to consumers, employers, even their provider colleagues. Shunning WellNow can cause negative ripples and unintended consequences in physician offices and ERs.

Third, Excellus members.

Instead of a paying the relatively nominal copay and receiving care in about an hour, Excellus members are now faced with either not getting care at all, (potentially dangerous) or paying the entire WellNow fee, which is considerably more than the copay or killing their day in an emergency room with a much higher copay in probably three to six hours.


Switching Medicare Plans

About half of our 66 million seniors have elected to be covered by a Medicare advantage plan versus traditional Medicare.

Advantage plans (MA) are funded by the federal government but administered by commercial insurance companies like Blue Cross, United, Aetna, Cigna, etc. You can switch back to traditional Medicare or switch to another MA plan during the two open enrollment periods: Jan. 1 through March 31 and Oct. 15 through Dec. 7. Medigap supplemental insurers can deny coverage of pre-existing conditions if you switch back to traditional from MA. However, Connecticut, Maine, Massachusetts and New York prohibit these insurers from denying care. There have been vocal critics of MA plans because of coverage issues and inaccurate provider lists. Beginning this year, MA plans must comply with federal network expectations or face consequences.


CVS in the Metaverse

For better or worse, the national drug chain has filed a patent to sell drugs in the virtual world. Surely, others will follow. CVS plans a dwindling physical presence and will close 900 stores over the next three years. It will offer healthcare services via three main platforms. Traditional stores that remain open will continue to provide prescription services and health and wellness programs. Free standing clinics will provide primary care services. HealthHUB locations will offer screenings, monitoring, counseling and other treatment options. CVS reported $304 billion in revenue is 2022.


Fighting Gun Violence

It is the No. 1 cause of death between the ages of 1 and 25. Since gun violence prevention is virtually stalled in Congress, several states have taken the matter up themselves and have authorized the use of their Medicaid dollars for gun violence prevention. They are California, Colorado, Connecticut, Illinois, Maryland, New York and Oregon. President has authorized the use of federal Medicaid dollars to supplement state efforts. 54% of gun deaths are suicide; 43% are murder; the remaining 3% are accidental or undetermined.


Fake Ozempic

There should be no surprise that there are fake versions of the popular weight loss drug on the market. The FDA has seized thousands of fake units and — with manufacturer Novo Nordisk’s cooperation — is testing for defects. So far, it appears the fake drug can result in infections and comes with unsterile needles. But rest assured the fake Ozempic still has the same adverse side effects as the real thing: nausea, vomiting, diarrhea, abdominal pain and constipation. Ozempic is a class GLO-1 drug originally designed to treat diabetes. But its popularity as a weight loss drug could cost Medicare an additional $14 billion to $27 billion per an analysis by the Kaiser Family Foundation. So far, according to a survey of HR professionals, only about 25% of employers cover the drug for non-diabetic treatment.


Drug Prices

The New Year means annual drug price increases. Last year, manufacturers jacked up prices on 1,425 drugs, which is slightly less than 1,460 in 2022. Leading the way is Pfizer, which accounts for more than 25% of the price increases. While Medicare won’t be authorized to negotiate drug prices until 2026 (and then only 10 drugs), starting this year, the Inflation Reduction Act limits price increases to inflation.


Price Transparency

Hospitals and payers are slowly complying with federal regulations regarding price transparency. 83% have posted negotiated rates with payers; 77% have posted cash rates; 80% have posted surgery rates; 65% have posted diagnostic rates like lab and X-ray. In addition, as of November 2023, 205 payers had posted what they pay for certain procedures and tests. Last December, the House passed the “Lower Cost, More Transparency” law which is now in the hands of the Senate. While it is smart to check out prices, just where you’ll receive healthcare will most likely be determined by your provider or your healthcare system.



George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at