Altru Health System patients and their health insurance providers pay more for their care on average compared with patients at regional competitors but pay close to the Minnesota statewide average, according to a recent report.
A 2015 MN Community Measurement report analyzing medical costs in the state and neighboring communities found Altru patients and their insurance plans pay an overall average cost of $502 per patient per month. That’s higher than patients of Fargo-based Sanford Health’s many Minnesota clinics and patients of rural clinics near Fosston and Crookston.
However, Altru patients and their plans pay an average amount compared with the overall average cost in Minnesota, which is $449 per patient per month, according to the organization’s Total Cost of Care report.
The total cost of medical care in that state increased by 3 percent since last year for patients with commercial insurers, while the average price of common tests, procedures and services in clinics increased by 6 percent.
Consumers can compare the cost and quality of medical procedures online for hundreds of clinics, mostly located in Minnesota. Border communities in North Dakota, Wisconsin, Iowa and South Dakota are also included.
The report was compiled by the nonprofit MN Community Measurement, which analyzes health care data with the goal of improving health results.
Officials from Altru, Sanford Health and Essentia Health supported the research, which they say will help inform consumer decisions and keep providers accountable.
Cathy VonRueden, vice president of payor contracting and strategy for Essentia Health, was a member of the task force that helped create the report. Publishing costs met some resistance among health providers, but the company also sees benefits to sharing accurate and meaningful data, she said.
“Every year, we want to get better and better and provide more information, so both the providers and consumers can look at this and make some conclusions,” she said.
The second-annual Total Cost of Care report is expansive, including data from more than 1.5 million patients with commercial insurance providers and ratings on up to 85 common medical procedures.
The results are based on 2014 insurance claims from Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica and PreferredOne.
Medical providers needed to have at least 600 patients with claims across at least three health plans to be included in individual results, but all patients were included in the statewide averages.
Altru’s overall office costs were close to the state average, while lab costs were higher in every category.
In a separate MN Community Measurement report Altru was also found to provide average or below-average care for several procedures, including treatment for depression, colon cancer screening and cesarian-section delivery.
Altru officials didn’t dispute the findings but noted the report only represents about 10 percent of its total patient population. About 23 percent of its patients are from Minnesota—one third of whom have commercial insurance—and the report covers about 7.6 percent of its total patients, they said. When Altru assesses quality improvement performance, the system examines all patients, they said.
“When we look at our total population of patients, we have a higher compliance than what’s reported in that one report,” said Heather Strandell, administrative director of quality and care management. “We’re doing really well with the quality in how we treat patients.”
Health officials from Essentia and Sanford said they weren’t surprised by the results. They did say costs can vary depending on the specialty services offered at certain clinics.
“They maybe have to have a little bit higher costs to support those departments,” said VonRueden of Essentia.
Medicare and Medicaid patient data is not included in the report. Altru officials say that 43 percent of its patients use Medicare for coverage. These patients are older adults who experience greater health challenges and have a greater chance of developing chronic disease.
Altru aims to keep its cost for those patients in the middle range, said Chief Financial Officer Dwight Thompson. Data from the hospital system shows it sets costs that are lower than Sanford Health but higher than Essentia.
Officials from Sanford Health and Essentia Health said the Total Cost of Care report is comprehensive and draws from a large sample size. Depending on the region and number of clinics within the sample size, both providers’ costs fell into the average or higher-than-average category.
The cost per month for Medicare and Medicaid patients would be “vastly different” than a commercial patient, said Martha Leclerc, senior vice president of finance for Sanford Health.
But, “you don’t have to have 100 percent of all businesses in an open bucket to make conclusions,” she said. “It does represent a very large sample size.”
Quality and improvement
Officials with Altru, Sanford and Essentia say care has improved at clinics since the quality report assessed medical procedures using 2013-14 data.
The report includes data on 871 clinics. Not every medical procedure in a clinic could be rated because of a lack of data.
The quality and cost reports are two separate studies, but are both from MN Community Measurement.
Altru’s clinics received average to below-average ratings, but the number of procedures eligible for rating at individual clinics was usually no more than six. The system has made “significant improvement” controlling vascular disease, for example, but is “unsure of (the report’s) scale for average or below average,” said Strandell.
Altru is constantly working to help patients manage their care, she said. Health coaches assist patients in a variety of ways, whether that’s connecting them with community resources such as Meals on Wheels or providing outreach between physician visits, she said.
Essentia and Sanford Health both received a mix of ratings ranging from “top performer” to “below average.”
Sanford Health has increased its overall optimal control of asthma patients from 25 percent to 60 percent, said Megan Goldammer, chief clinical officer. The entire system and all of its patients are on one electronic medical record, or EMR, and the provider has been able to take its best practices for asthma care and embed it into the EMR, which helped improve the quality of care, she said.
Similarly, Essentia has invested a lot into its EMR system, which refreshes patient data on a weekly basis and tells staff which patients may need more attention, said VonRueden.
Several health officials said the comparison is just one aspect to consider when seeking care, though they should weigh cost and quality. But the report pushes all providers to improve, they said.
“We can also learn from other health care providers and ultimately, it’s the patient that benefits,” said Maureen Talarico, spokeswoman for Essentia Health.
Here is the average per-patient monthly cost in three categories—all patients, adult patients ages 18 to 64 and child patients ages 1 to 17—and how it compares to the overall average in Minnesota.
The overall cost per patient, per month statewide is $449. For adult patients, it’s $529 per month and for pediatric patients it is $225.
Altru Health System: 16 associated clinics
- Overall average cost: $502 Average
- Adult cost: $606 Average
- Child cost: $205 Average
RiverView Health based in Crookston: 6 associated clinics
- Overall average cost: $487 Average
- Adult cost: $578 Average
- Child cost: $231 Average
Essentia Health in Fosston: 3 associated clinics
- Overall average cost: $479
- Adult cost: $579
- Child cost: N/A
Sanford Health Fargo Region: 65 associated clinics
- Overall average cost: $437 Average
- Adult cost: $520 Average
- Child cost: $202 Average