Hospital-Physician Alignment Improves Health Care Quality, Creates $13.2M Savings

WASHINGTON, May 3, 2012 /PRNewswire/ -- Two hospitals and one health system are now delivering improved clinical outcomes at lower cost, thanks to a concerted move toward accountable care that promotes hospital-physician collaboration and leverages physician-level cost and quality performance data. 

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On May 3 in Orlando, The Advisory Board Company will honor these institutions with the 2012 Crimson Physician Partnership Award for improving the quality of care they provide while documenting more than $13.2 million in aggregate savings: 

Virginia Hospital Center (Arlington),Alegent Health (Omaha), and Monmouth Medical Center (Long Branch, N.J.).

The award presentation will take place at the Crimson Annual Performance Summit at the JW Marriott Orlando Grande Lakes in Orlando.  The awards, now in their third year, are presented to administrator-physician leadership teams at organizations that are members of the Crimson physician performance technologies cohort.  Crimson (R) is a program from The Advisory Board Company that helps hospitals and health systems advance quality goals and secure cost savings by eliminating inefficiencies in care delivery. 

Virginia Hospital Center Improves Clinical Documentation

The 342-bed facility found that its clinical documentation often did not reflect the complexity of pneumonia being treated.  At the same time, the hospital was experiencing financial losses due to fast-rising numbers of Medicare patients, and physician performance data showed that the greatest losses were occurring across ventilated patients.  The institution utilized quality and cost performance data to engage physicians on improving documentation and clinical performance, resulting in a 38% decrease in its mortality observed/expected ratio, a 14% decrease in average length of stay , and a 26% reduction in cost per case.  The net financial impact of the efforts was annualized savings of more than $635,000. 

"We have been preparing Virginia Hospital Center and our physicians for a new era of public accountability when consumers will have unprecedented access to a wide range of data such as readmissions and patient surveys," said Jeffrey DiLisi, MD, Vice President and Chief Medical Officer at Virginia Hospital Center.  "We have had success with our physicians in improving clinical documentation–and the resulting care outcomes–because our physicians have been able to see the impact on quality of care and on their great reputations.  Crimson has enabled us to make performance data transparent so we can eliminate documentation errors and move toward breaking even on Medicare cases." 

Alegent Health Enhances Care Effectiveness and Efficiency

This 10-hospital health system has physicians and nurses aligned to collaborate with interdisciplinary care teams at each of its facilities to reduce unnecessary utilization of medical resources.  The system's 100-day "Care Redesign" projects have yielded more than $2 million in annualized savings.  The system also improved or maintained 98.9% of its quality metrics for targeted diagnoses; further, patient experience scores showed a record improvement.  For example, Alegent Health Lakeside Hospital, a 157-bed hospital in Omaha, focused on nonhemorrhagic stroke patients and eliminated complications of care for 13 months. 

"Our culture of clinical improvement has grown with rapid-cycle Care Redesign projects," said Rick Miller, DO, Senior Vice President and Chief Quality Officer, Alegent Health.  "For each diagnosis-specific project, case managers, nurses, physicians, and therapists work together to identify a specific opportunity to reduce resource utilization and meet weekly with a system-level steering committee to discuss progress and results.  It's a repeatable process that has allowed us to share best practices across the system and among physicians.  This never would have been possible without Crimson's outstanding tool for collaboration with clinicians." 

Monmouth Medical Center Lifts Clinical Effectiveness Institutionwide

Since 2008, this 527-bed teaching hospital has developed care efficiency initiatives across clinical areas such as joint replacements, vaginal deliveries, and heart failure.  In addition to contributing $10.6 million in cost savings, these projects have also driven widespread improvement in key quality measures.  In 2007 Monmouth ranked among the top 10% of U.S. hospitals on 16 of 24 core measures for quality (67%) but in 2011 did so on 23 of 24 core measures (96%). 

"For decades we've been working to improve care quality while reducing costs," said Thomas Heleotis, MD, VP of Clinical Effectiveness for Monmouth Medical Center.  "The breakthrough came when we were able to engage physicians on their performance data through the use of Crimson.  Now that physicians can easily look up their own data and track their performance, they can see clear, actionable steps for clinical improvement." 

Out of a national Crimson cohort of more than 550 individual hospitals representing more than 360,000 physicians, these three institutions have distinguished themselves as leaders in care efficiency.  "The Physician Partnership Award winning- institutions have made key, long-term organizational gains that will benefit patients and their communities," said Paul Roscoe, CEO, Crimson.  "By engaging their physicians in meaningful ways through quality and cost performance data, these institutions have strengthened the alignment needed to succeed under risk-based payments from private and public payers." 

For more information on the 2012 Crimson Physician Partnership Awards, including videos on the award winners, visit http://www.advisory.com/award. 

About Virginia Hospital Center

For over 60 years, Virginia Hospital Center has provided exceptional medical services to the Washington metropolitan area.  Virginia Hospital Center is a 342-bed, $150 million state-of-the-art facility offering comprehensive healthcare and multiple Centers of Excellence including Cardiology & Cardiovascular Surgery, the Reinsch Pierce Family Center for Breast Health, Neuroscience, Oncology, Total Joint Replacement (hip and knee), Women & Infant Health and Urology.  Growing service lines include Executive Health and the only Lung Cancer Center in northern Virginia.  Virginia Hospital Center is a teaching hospital, long-associated with Georgetown University's School of Medicine, and accredited by The Joint Commission and Licensed by the Commonwealth of Virginia Department of Health.  For additional information, please visit www.VirginiaHospitalCenter.com.

About Alegent Health

With a commitment to providing high-quality care and an exceptional patient experience, Alegent Health, its 1,300 physicians and 8,600 employees are focused on caring for the body, mind and spirit of every person. Patients find a continuum of care at Alegent Health, from primary care through geriatrics. Families can also find specialty care at Alegent Health including women's and children's, cardiovascular, orthopedics, spine, oncology, physical rehabilitation and behavioral health services. With the blessing of our sponsors, Catholic Health Initiatives and Immanuel, Alegent Health has 10 hospitals, freestanding inpatient psychiatric and skilled nursing facilities and more than 100 sites of service making us the largest not-for-profit, faith-based healthcare provider in Nebraska and southwest Iowa. For more information, visit www.alegent.com.

About Monmouth Medical Center

Monmouth Medical Center, an affiliate of Barnabas Health, along with the Children's Hospital at Monmouth Medical Center, is one of New Jersey's largest academic medical centers and has been a teaching affiliate of Philadelphia's Drexel University College of Medicine for more than 40 years.  From its earliest days, Monmouth Medical Center has been a leader in surgical advancement and has introduced many technological firsts to the region, including robotic surgery and other minimally invasive techniques.  The hospital is routinely recognized by HealthGrades, the nation's largest premier independent health care quality company, for excellence in both emergency medicine and maternity care.  U.S. News & World Report has recognized Monmouth as a regional leader in cancer, geriatrics, gynecology, neurology and neurosurgery.  For more information on Monmouth Medical Center, visit www.barnabashealth.org.

About The Advisory Board Company

The Advisory Board Company is a global technology, research, and consulting firm partnering with 125,000 leaders in 3,700 organizations across health care and higher education. Through its innovative membership model, the firm collaborates with executives and their teams to elevate performance and solve their most pressing challenges.  The company provides strategic guidance, actionable insights, web-based software solutions, and comprehensive implementation and management services.  Through its Crimson offerings, The Advisory Board Company collaborates with health care providers dedicated to strengthening hospital-physician alignment, coordination among care settings, and overall clinical performance.  Combining business intelligence technology with best practice implementation, Crimson offerings are developed with hospitals, health systems, physicians, and other practitioners seeking improved alignment on key clinical, operational and strategic goals.  For more information about The Advisory Board Company, visit http://www.advisory.com.

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How Obamacare Will Make Health Savings Accounts More Costly

WASHINGTON - AUGUST 19: Health and Human Services Secretary Kathleen Sebelius speaks during a news conference on August 19, 2010 in Washington, DC. (Image credit: Getty Images North America via @daylife)

In February, the U.S. Department of Health and Human Services issued a “guidance bulletin” regarding the compatibility of health savings accounts with Obamacare’s insurance regulations. According to HSA expert Roy Ramthun, the news isn’t good. “HSA plans will not be as affordable as they are today,” says Ramthun.

It all hinges around a technical term called “actuarial value.” Actuarial value is an insurance concept that defines, on average, the fraction of costs that a particular insurance plan will cover, versus requiring the beneficiary to pay directly. For example, a health insurance plan with an actuarial value of 70 percent would, on average, require its beneficiaries to directly pay 30 percent of the covered health expenses, through co-pays, deductibles, and the like. The rest would be paid indirectly, through the insurance premium.

The problem is that health savings accounts aren’t really compatible with conventional “actuarial value” calculations. If you have a consumer-driven health plan consisting of high-deductible insurance and a health savings account, and you don’t count the HSA as a “health expenditure,” the actuarial value of your plan could be extremely low. On the other hand, if HSA savings are counted as a form of health spending, the actuarial value of your plan could be quite high.

As usual, under our new health law, the government gets to decide these things on our behalf. Sections 1302 and 1402 of the Affordable Care Act regulate insurance plans offered in the individual and small-group markets (i.e., the markets for insurance for those who buy it on their own, and for small companies with less than 100 employees). Plans are required to have a minimum actuarial value of 60 percent (the “bronze plan”). I’ve written in the past about how this provision in the law will substantially drive up the cost of insurance, and damage the private insurance market through an adverse selection death spiral.

“The guidance is a mixed bag,” says Ramthun. The HHS guidance does allow employers to include the contributions they make to health savings accounts or health reimbursement accounts (HRAs). But contributions that individuals make into their own HSAs or HRAs won’t count. That’s particularly harmful to people who buy insurance for themselves on the individual market.

In the wonky language of the guidance bulletin: “In calculating the combined [high-deductible health plan] and HSA or combined employer health benefit plan and HRA, the [actuarial value] calculation would assume that the employer contribution to the HSA or HRA is used by the employee to pay for cost-sharing. Accordingly, these amounts would be credited to the numerator of the AV calculation…In the individual market, we intend to propose that HSA contributions paid directly by the individual would not count towards AV.”

“This will make it much more difficult for high deductible plans to meet the minimum actuarial value standard of 60 percent,” says Ramthun. “If they can’t, these plans will either not be available, or these plans will have to raise their values by covering additional benefit expenses. This in turns means the premiums will have to be increased to cover the additional expenses, meaning HSA plans will not be as affordable as they are today.”

The free-market approach to health care involves going in exactly the opposite direction: encouraging even more people to save money for their own health expenses using health savings accounts. It’s when you pay for something directly that you are most likely to make sure that you’re paying for value. When other people pay on your behalf—whether that third party is a private-sector insurer or the government—you’re not going to shop for value. The examples of Singapore and Switzerland show that paying directly for one’s own care makes a big difference. Obamacare’s central flaw is that the law makes it harder for us to do so.

Follow Avik on Twitter at @aviksaroy.

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Health Savings Accounts Help Consumers Save on Their Taxes and Health Care

INDIANAPOLIS--(BUSINESS WIRE)--

As 2011 W-2 forms and 1099s start arriving in mailboxes throughout the country, now is the time to remind taxpayers with health savings accounts (HSAs) that they have until April 17 to contribute to their HSAs to maximize their 2011 deductions, up to the legal limit.

For 2011, HSA contributions are tax deductible up to $3,050 for individuals and up to $6,150 for families. HSA holders who are 55 and older can deduct an additional $1,000. In 2012, tax-deductible contribution limits have been increased to $3,100 for individuals and $6,250 for families.

Health savings accounts have two components: a tax-advantaged savings account coupled with a high-deductible health insurance plan. In addition to the tax savings, a high deductible health insurance plan paired with an HSA typically costs significantly less in monthly premiums compared to more traditional health insurance while still providing quality coverage, including preventive care.

Savings deposited into an HSA grow tax-deferred and can be withdrawn tax-free as long as the HSA dollars are used for qualified medical expenses, which include health insurance deductibles as well as vision and dental care that are not covered by health insurance plans.

“HSAs make sound financial sense because they enable consumers to save tax-free for their current and future medical needs,” said Richard A. Collins, CEO, UnitedHealthcare’s Golden Rule Insurance Company.

According to a recent Fidelity Investments® survey, “almost seven in 10 (68 percent) of pre-retirees said the cost of medical care in retirement is one of their three biggest financial concerns.”

“Unspent HSA savings can accumulate year after year, earning interest. This helps build up a ‘medical nest egg’ that can be valuable later in life when health care needs can increase significantly,” Collins said.

To learn more about HSAs, visit www.HSAcenter.com, an interactive online resource developed by Golden Rule to educate consumers about the advantages that health savings accounts offer. Golden Rule’s expertise in the consumer-directed health care market goes back more than 20 years when the company introduced the first medical savings account (MSA), predecessor to the HSA.

About Golden Rule

A leading provider of health insurance for individuals and families for 65 years, Golden Rule has been a UnitedHealthcare company since 2003. UnitedHealthcare’s personal health and dental plans are offered in 41 states and the District of Columbia, and marketed under the UnitedHealthOne brand. For more information, consumers can call 1-800-444-8990, visit www.goldenrule.com or contact a local independent insurance broker who offers UnitedHealthOne health and dental plans.

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Health Savings Accounts Surpass $12.4 Billion Accounts in 2011

MINNEAPOLIS--(BUSINESS WIRE)-- Health Savings Accounts (HSAs) surpassed $12.4 billion in assets in almost 6.8 million accounts by year-end 2011 according to a survey and resulting research report conducted by Devenir, an investment firm that specializes in providing investment options for HSAs.

The survey data was collected in January, 2012 and primarily consisted of the top 50 HSA providers in the health savings account market, with all data being collected for the December 31st, 2011 period. “We continue to see strong growth in the HSA marketplace as well as steady increases in average balances,” says Eric Remjeske President and Co-Founder of Devenir.

Key findings from the Devenir December 2011 survey and research report:

Steady growth. HSAs continue to see consistent growth as the total number of HSA accounts rose to almost 6.8 million with assets totaling $12.4 billion, a year over year increase of almost 20% for accounts and a 26% increase in assets for the period from December 31st, 2010 to December 31st, 2011. Average account balance at the end of 2011 grew to $1,841 from $1,751 at the end 2010, a 5.1% increase. When you eliminate identified zero balance accounts that average rises to $2,179. Existing accounts average balances have grown at an average of 31% each year from the year they were opened since 2005. Contributions and Withdrawals industry wide carried forward 24% of their contributions over the past year into 2012. HSA investment dollars continue to grow. HSA investment assets reached an estimated $960 million in December, a 34% year over year increase and are projected to reach $4.7 billion by the end of 2015.

“With the data suggesting that the average HSA balance continues to grow steadily the longer the account has been opened, HSAs are demonstrating that they are serving their purpose and helping consumers save for future healthcare expenses,” according to Jon Robb, Lead Research Associate with Devenir. Devenir projects the HSA market to reach $27.6 billion in assets by the end of 20151. Devenir also projects that HSA investment dollars will continue to grow quickly as health savings account user’s balances become larger, representing 17% of all HSA assets by the end of 2015.

Estimates are derived from the Year-End 2011 Devenir HSA survey, press release and, previous market research.

1 Projections are barring any dramatic regulatory or market environment changes.

Forward-looking statements are based on current expectations and assumptions based on historical growth, the economy, other future conditions and forecasts of future events, circumstances and results.

About Devenir

Devenir, a full-service broker dealer and registered investment advisor based in Minneapolis, is a national leader in providing customized investment solutions to the HSA Custodian marketplace. As an HSA industry leading investment firm, Devenir offers a host of investment options to suit the unique needs of employers, banks, third party administrators and plan participants. www.devenir.com

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