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.

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.

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

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