Outsourcing to Optum – One Healthcare System’s View

Health systems across the country are seeking to reduce costs and increase efficiencies by outsourcing administrative work to UnitedHealth Group’s organization, Optum. Bassett Healthcare Network in rural New York has partnered with Optum for two years and relays the benefits of working with Optum.

After an honest self-assessment, Bassett Healthcare Network decided that information technology (IT), recruiting talent, and cybersecurity provided the most opportunities for improvement with Optum. Bassett was adamant that the partnership value them as a unique organization with a unique community. As a historically relevant organization, a culture fit was also essential to Bassett, and Optum respected that approach.

The return on investment has been a savings of $25 million per year thus far and is expected to save $250 million over 10 years. In addition to providing systemic efficiencies, the Optum partnership allowed Bassett’s employees the opportunity to grow within a new structure with new opportunities.

Source: Becker’s Hospital Review

It’s Not You—Specialty Drugs are Increasing in Cost

Specialty drugs treat conditions such as cancer, cystic fibrosis, rheumatoid arthritis, Crohn’s disease, and more. Because of their personalized approach, and ongoing monitoring, specialty drugs are more expensive. Additionally, the use of specialty drugs is on the rise, which also increases costs.

Artemetrx creates an annual State of Specialty Spend and Trend Report, and according to their report, the net of rebates rose to 12.5% in 2022, which is an increase of 3.6% over 2021. As high-cost therapies enter the market and current uses for specialty drugs are expanded, costs per claim are rising.

Source: BenefitsPro.com

California Supreme Court Allows Aetna Lawsuit

In 2012 the California Medical Association (CMA) sued Aetna for retaliating against providers who sent clients to out-of-network clinics. The lawsuit was put down by a judge and state appeals court who said the CMA didn’t have a legal standing to sue.

The lawsuit alleges that Aetna terminated contract physicians who referred patients to “out-of-network ambulatory surgery clinics”. Aetna claims the policy was created to encourage physicians to refer in-network and help patients avoid surprise bills, but also to discourage providers from referring to clinics in which they have financial interests.

Justices in the California Supreme Court determined that the CMA had legal standing to sue because the organization “devoted substantial resources to dealing with the insurer’s policy and thus had standing to sue for injunctive relief under the state’s unfair competition law.”

Source: BenefitsPro.com

Is Hospital Consolidation Harming Healthcare? Elevance Study Says Yes

A new report from Elevance Health found that when large health systems purchase and consolidate independent hospitals, prices rose even while operating costs decreased.

The report compared independent hospitals that merged with hospital systems to independent hospitals that remain independent. The study showed that operating expenses decreased by 6% for consolidated hospitals due to cuts in personnel including general and administrative, employee benefits management, maintenance, supply oversight, and purchasing, pharmacies, and medical records filing and storage. Read more on our website.  

The report says that the costs for commercially insured patients rose 5% more than the market average for independent hospitals. As patient volume declined over the past decade, independent hospital spending rose from 30% to 31%. Conversely, costs for consolidated hospital markets increased from 7% to 25% over the same time period. The American Hospital Association counters that the report was funded by a major insurer that is bringing in record profits while denying and delaying access to care. AHA CEO Rick Pollack said the report fails to consider the benefits of consolidation, especially for struggling rural hospitals and underserved communities.

Source: Fierce Healthcare

AI Could Help Physicians Order Right Imaging Tests

As artificial intelligence (AI) tools become increasingly popular, more industries, including healthcare, are experimenting to see how AI can help create efficiencies. A study conducted by researchers at Harvard and Mass General Brigham showed that ChatGPT is effective at choosing the correct imaging test for patients with breast pain. Read more on our website.

While AI won’t be a replacement for doctors, there are ways in which it can be used to help make workflow and administrative tasks more efficient. The study discovered that ChatGPT 3.5 chose the right imaging test 88.9% of the time, while the more advanced ChatGPT 4 chose the correct test 98.4% of the time.

AI technology could be incorporated into electronic health records (EHRs) to suggest appropriate imaging tests based on the patient’s symptoms. More research is required before AI has a solid place in healthcare. Additionally, privacy risks also need to be considered. However, AI isn’t going anywhere and researchers seek to find the benefits as well as the limitations of the new technology for healthcare.

Source: Healthcare Brew

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