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.