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St. Elizabeth Healthcare joins Anthem in effort to contain high-cost episodes of care or ‘shock claims’

With affordability a growing challenge in the healthcare system, one of Kentucky’s largest hospital systems and its largest health plan have partnered to help protect consumers and their employers from the potentially devastating impact of exceptionally expensive health services.
St. Elizabeth’s five hospitals are the first in Kentucky to voluntarily participate in Anthem Blue Cross and Blue Shield’s effort targeting a significant driver of healthcare costs: unexpected, exceptionally expensive health events and the rapid growth of specialty medications that can cost as much as $1 million per course of treatment.

Through the agreement, St. Elizabeth Healthcare will reduce charges for these high-cost episodes of care, known as “shock claims,” by as much as 45 percent.

Charge reductions will vary based on case-by-case specifics, but Anthem and St. Elizabeth say the savings will be significant in all cases and will result in more affordable healthcare for consumers and employers.
“We jumped at the chance to join this program because St. Elizabeth is committed to providing transparent and predictable pricing while helping Northern Kentucky employers offer affordable, high-quality health benefits to their employees,” said St. Elizabeth Vice President of Managed Care Bill Banks. “In fact, with average annual price increases of less than two percent, our healthcare charges are among the lowest of Kentucky’s large healthcare systems.”

Bill Banks

Shock claims, including those for care in neonatal intensive care units, cancer treatments, heart centers, and immunotherapy treatments, have nearly doubled since 2014 and can run as high as $6 million. Health events at this cost level can have a devastating impact on employers because many have self-funded health plans and pay for individual healthcare claims directly. Even employers that don’t pay directly can face drastically increased insurance premiums which can also impact costs for their employees.
“St. Elizabeth immediately stepping up to work with us on addressing shock claims is a perfect example of how the healthcare system can lower costs through collaboration and creative thinking,” said Kennan Wethington, commercial president of Anthem Blue Cross and Blue Shield in Kentucky. “We want to be the most innovative, valuable and inclusive partner as we work together to simplify healthcare. This partnership is a great example of that effort and will be a major relief for Northern Kentucky employers and Anthem consumers.”
Anthem launched the initiative in late May in hopes of getting all Kentucky hospitals to participate. As Kentucky’s largest commercial health insurer, statewide acceptance of this approach has the potential to significantly impact costs for all Kentuckians and their employers.

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One Comment

  1. Nancy LaFontaine says:

    What is the agreement that St. E. made to save money on Medicare claims? If they do,then at their assessment they will receive a monetary compensation to improve patient services OR to share with physicians,and if not they will be fined. I received a letter to this effect.

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