CASE STUDY: How Strategic Partnerships Can Deliver Insurance for the Uninsured, Cost Containment, & Revenue Cycle Lift
CASE STUDY:
How Strategic Partnerships Can
Deliver Insurance for the Uninsured,
Cost Containment, & Revenue Cycle Lift
How Strategic Partnerships Can Deliver Page | 1 © 2013 Accretive Health, Inc. Insurance for the Uninsured, Cost Containment, & Revenue Cycle Lift
Saint Anthony Hospital Overview
Founded in 1898, Saint Anthony Hospital is a faith based, non-profit community teaching hospital
dedicated to serving the health needs of Chicago’s Southwest Side. More than 800 physicians and staff
practice the founding principles of the hospital through their stewardship, generosity of spirit,
leadership, innovation and dedication.
With more than 8,000 annual admissions and 35,000 annual emergency department visits, Saint
Anthony prides itself on providing quality medical care, social services and strong community outreach
to the residents of Chicago’s Southwest Side.
The Business Challenge
Saint Anthony Hospital sought a partner that could keep pace with the continuous changes to the health
insurance landscape (especially CMS), and the rising cost of overhead that it takes to run a quality-
focused, independent community hospital.
Saint Anthony Hospital needed a partner that would help them advocate for their uninsured patients, as
well as deliver results through improved processes. These improvements needed to focus on achieving
reductions in operational denials, reducing uncompensated care where possible and supplementing
Saint Anthony resources without growing expenses. The hospital was faced with challenges like:
Emergency Department practices and productivity challenges that limited their ability to screen 100
percent of uninsured patients
Primary focus on Medicaid solutions due to training and technology challenges
Large undocumented patient population
Large percentage of patients without the ability to pay that were recorded as bad debt instead of
correctly recorded as charity care
Lack of resources and bandwidth to provide attention to process improvements
To add to the situation, there were significant management changes at Saint Anthony Hospital. In the
summer of 2007, the parent company of Saint Anthony Hospital hired a consulting firm to determine the
hospital’s viability. Guy A. Medaglia, Managing Director, along with his consulting team, reviewed every
aspect of the hospital’s operation and made changes that allowed Saint Anthony Hospital to become a
successful entity and eventually began the journey to separate from its parent and transition to an
independent community hospital.
How Strategic Partnerships Can Deliver Page | 2 © 2013 Accretive Health, Inc. Insurance for the Uninsured, Cost Containment, & Revenue Cycle Lift
After arriving, Mr. Medaglia and his team thoroughly re-evaluated Accretive Health’s services and
performance. Upon successful completion of the evaluation, Accretive Health’s services were
determined to be high quality and a good fit for Saint Anthony Hospital. After making the
recommendation to the Saint Anthony Hospital Board of Directors, Accretive Health was retained as a
partner through 2014.
The Accretive Health Solution -
A Healthcare Partner on a Mission
Accretive Health has implemented people, processes and
technology that improved cash received from gross
operating revenue. This was largely achieved through the
development and implementation of improved processes to
find insurance coverage for a majority of patients who were
seen at Saint Anthony Hospital. Upon arrival and
determination of these patients’ uninsured status, members
of the Accretive Health team worked diligently to identify
insurance coverage, and by doing so, provided a solution for
the patient and payment to the hospital. Over the past six
years, Accretive Health has acted as a patient advocate and
secured insurance coverage for more than 25,000 uninsured
patients who received medical services at Saint Anthony
Hospital. This was achieved by Accretive Health’s funding of
additional staff and vendors to more than triple Medicaid
applications in the first two years, and that rate continues
today.
In addition, they identified and established a process to
obtain government (CMS) 1011 Funds for undocumented
patients that resulted in approximately $5 million in
reimbursements to Saint Anthony Hospital.
Further initiatives included implementation of reviews of the Saint Anthony Charge Master (CDM) which
resulted in increased reimbursement of over $1 million over the last four years. Through improvements
in competitive vendor contracts and staff productivity, the hospital realized more than $1.5 million in
rebates in revenue cycle costs since 2008.
The partnership has provided other value-added support in both staffing and assistance during
significant one-time events. During a Saint Anthony Hospital staff transition, Accretive Health stepped in
to assist, at no additional charge, until the hospital was able to recruit new leadership. Accretive Health
leaders participated in establishing an environment to support CMS’s Recovery Audit Program (RAC) to
“When I find a Saint Anthony Hospital
partner that has demonstrated, over a
long period of time, that they can help
to improve quality and help lower
cost, I want to make sure others are
made aware of this partnership and
what they have done for us in the
areas of cost containment, revenue
cycle strategies, and reimbursement
to name just a few.”
Guy A. Medaglia,
President & Chief Executive Officer of
Saint Anthony Hospital, Chicago
How Strategic Partnerships Can Deliver Page | 3 © 2013 Accretive Health, Inc. Insurance for the Uninsured, Cost Containment, & Revenue Cycle Lift
include Accretive Health people, process and technology
and formation of a RAC steering committee. In July 2009,
Saint Anthony Hospital initiated a two-year program to
convert to a new Patient Accounting System to include
electronic health records. Accretive Health fully supported
this transformational project, tackling the numerous
challenges to the revenue cycle processes (payer and
patient billing, AR reporting, HIM processes, and staffing
changes).
Lastly, Saint Anthony Hospital is steadfast in the belief that
every patient should be treated with dignity, compassion
and respect. Accretive Health has been diligent in following
the hospital patient collection and charity practices, as well
as keeping all appropriate laws, regulations and the
community mission that guides Saint Anthony Hospital.
Throughout the course of the relationship, a strong team of
dedicated professionals from Saint Anthony Hospital and
Accretive Health emerged. Together, they developed best practice solutions for obtaining insurance for
the uninsured, reducing revenue cycle leakage and improving processes.
Results of the Partnership
The partnership between Saint Anthony Hospital and Accretive Health has helped the hospital improve
cash received from gross operating revenue by more than $19 million since 2006. More than 90
percent of the revenue has been from the work Accretive Health has done to identify insurance
solutions for the uninsured which keeps a focus on the Saint Anthony Hospital mission of providing
quality care to the communities they serve.
Why Accretive Health – An Operating Partner on a Mission
We deploy our highly skilled people, proven best practice processes and advanced proprietary
technology and analytics at our client’s sites. When financial results directly attributable to improved
performance are achieved, we share in the economic value created. There is no other value-based
model in the market like ours. We are completely aligned with the mission of our clients in a highly
accountable way and we do this with a strong focus on the dignity, compassion and respect of the
patients that we have the privilege to serve.
“One of the things we value most
about any partner that we do
business with is what they bring to
the table in terms of extra value and
whether or not they are partners and
not just another vendor.
Accretive Health is truly a partner that
delivers value beyond our business
expectations. They go above and
beyond and even participate in our
community goals of improving the
overall health of our community.”
Guy A. Medaglia,
President & Chief Executive Officer of
Saint Anthony Hospital, Chicago
How Strategic Partnerships Can Deliver Page | 4 © 2013 Accretive Health, Inc. Insurance for the Uninsured, Cost Containment, & Revenue Cycle Lift
About Accretive Health, Inc.
Founded in 2003, Accretive Health’s mission is to help healthcare providers strengthen their financial
stability and deliver higher quality, more accessible care to its clients’ patients and the communities they
serve. The majority of the hospitals that Accretive Health serves are non-profit, faith-based hospitals or
teaching hospitals, deeply rooted in values of stewardship, generosity of spirit, leadership and
dedication to their communities.
With approximately 2,900 employees, Accretive Health serves many of the top-rated hospital systems in
the country and is committed to providing solutions that assist them in the delivery of quality healthcare
services and maintaining financial stability.