Independent hospital consortium reaches value-based care deal

A Kentucky-based health insurer has struck the first value-based care contract for Bridges Health Partners, the consortium of four independent hospitals in western Pennsylvania.

Humana Inc. (NYSE: HUM) and Bridges began the agreement Jan. 1, 2019, for its Medicare Advantage members in western Pennsylvania. While specific local numbers weren’t available, Humana has about 47,000 Medicare Advantage members in the state. Value-based insurance contracts seek to save adverse health effects and costs down the line by promoting among members both early tests and interventions like breast-cancer and colon-cancer screenings and adherence to medications.

Bridges is the clinically integrated network between St. Clair Hospital, Excela Health System, Washington Health System and Butler Health System. It’s an accountable care organization (ACO) that offers value-based care for traditional Medicare patients, but the deal with Humana is the first time Bridges has reached a value-based agreement with a commercial insurer.

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This local hospital has a financial tool to get at the true costs of procedures for patients — and it’s not chargemaster

While new federal regulations required all hospitals to publish online a list of charges for procedures, supplies and drugs, no one thinks the move goes far enough to help get at the true cost to patients. But one local hospital has been doing just that for the past three years.

St. Clair Hospital in February 2016 rolled out its financial tools webpage that provides patients with an estimate of out-of-pocket costs for common hospital procedures, including surgery, colonoscopy, CT scans and sleep studies.

“A lot of patients are really price sensitive, especially patients who have a higher deductible, who know they will be responsible for a larger part of health care expenses,” said Beth Pittman, VP and COO of St. Clair Medical Services.

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Prescription for Success: St. Clair Hospital Prospers in Tough Climate

Community hospitals do more than provide access to medical care

Community hospitals are struggling, partly because of low Medicare and Medicaid reimbursements and private insurers’ emphasis on outpatient care.

Yet St. Clair Hospital is prospering in this dog-eat-dog world despite its proximity to the big health care institutions in Pittsburgh. That’s good news for the South Hills — the hospital is located in Mt. Lebanon — and St. Clair’s success offers hope for other community hospitals, too.

As the Post-Gazette’s Kris B. Mamula reported Sunday, St. Clair finished the 2018 fiscal year with a remarkable operating margin of 12.2 percent. That’s up 23 percent from 2017 and leaps and abounds ahead of the 4.6 operating margin that is the average among Western Pennsylvania hospitals.

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St. Clair Hospital To Undergo $142 Million Expansion

St. Clair Hospital Joins Mayo Clinic Care Network

PITTSBURGH, Pa. – St. Clair Hospital is the newest member of the Mayo Clinic Care Network, a growing national network of independent health care providers committed to serving patients and their families through clinical collaboration.

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Emergency Departments Bustling With Heat-Related Illnesses As Temperatures Climb

PITTSBURGH (KDKA) — Some local emergency departments are bustling with cases of dehydration and respiratory problems — consequences of the heat.

“In the winter, it’s flu, and in the summer, it’s injuries and heat-related things,” says St. Clair Hospital emergency medicine physician Dr. Jason Biggs. “This week, we’ve seen an increase over the past several days. People especially going outside doing landscaping, exercising, that tends to lead to problems. And that’s who we end up seeing in the emergency department.”
St. Clair’s Chair of Emergency Medicine, Jason Biggs, M.D., discusses how to protect yourself