St. Elizabeth Regional Health opts out of Anthem network November 2

LAFAYETTE, Ind. -– The Sisters of St. Francis Health Services Inc. (SSFHS) announced October 13 that its contract with Anthem Blue Cross and Blue Shield of Indiana is set to end November 2, 2008.

Reasons for the termination include Anthem’s lack of accurate and timely claims payment and the inability to secure contract terms comparable to other hospitals in the area, SSFHS officials said.

The termination will cover the following SSFHS hospitals and physicians:

• St. Elizabeth Regional Health, including St. Elizabeth Medical Center and Home Hospital in Lafayette;
• St. Clare Medical Center in Crawfordsville;
• St. Francis Hospital & Health Center in Indianapolis;
• St. Francis Hospital & Health Center in Beech Grove;
• St. Francis Hospital & Health Center in Mooresville;
• St. Anthony Medical Center in Crown Point;
• St. Anthony Memorial Health Center in Michigan City;
• St. Margaret Mercy Healthcare Center in Hammond;
• St. Margaret Mercy Healthcare Center in Dyer;
• Franciscan Physicians Hospital in Munster; and
• More than 300 physicians in the different SSFHS service areas.

“SSFHS is a good partner that works closely with payers to resolve claims problems when they occur,” said Greg Yust, SSFHS vice president of managed care contracting. “We recently forged successful long-term agreements with Aetna, Humana, Sagamore and CIGNA. The Anthem claims issues have been ongoing for more than a year with no progress whatsoever.”

St. Elizabeth hopes to work out a new agreement with Anthem. In the event SSFHS is unable to reach an agreement, it will continue to work with Anthem, patients and employers to limit the impact the contract dispute might cause.

Sisters of St. Francis Health Services announce new vice president for Innovation

MISHAWAKA, IND. — The Sisters of St. Francis Health Services (SSFHS) is pleased to announce that James C. Sparks, Ph.D. has been appointed vice president for Innovation for SSFHS.

Dr. Sparks received his bachelor’s of science and doctorate degrees in biology and biochemistry from the University of Tennessee at Knoxville, and he received his post-doctoral training in clinical laboratory science at the University of Tennessee Memorial Research Center and Hospital in Knoxville. Dr. Sparks is an associate fellow of the National Academy of Clinical Biochemistry and has more than 35 years experience in health care operations, primarily in the clinical laboratory arena.

In his new role, Dr. Sparks will work with SSFHS’ senior leadership and with system and hospital medical, quality and performance improvement leaders to identify and share operational and clinical best practice standards and processes throughout the system. He will also facilitate a system-wide approach to new and emerging health care technology identification and evaluation using existing technology assessment teams and processes to develop transparent and consistent approaches and strategies in this key capital investment arena.

Dr. Sparks previously served SSFHS as the president and CEO of their seminal central laboratory venture and was instrumental in leading the merger of its operations with the laboratory operations of two other health care systems in the Chicago area – Provena Health and Resurrection Health Care. Prior to his service at SSFHS, Dr. Sparks was a member of senior leadership at Specialty Laboratories, Genzyme Genetics, Nichols Institute and SmithKline Beecham Clinical Laboratories. He also served as an independent consultant to pathology practices and to biotechnology entrepreneurs and investors.

“Purposeful, worthwhile work and the opportunity to make a difference in the lives of others have all been part of my experience over the years I have been part of SSFHS. Our mission of continuing Christ’s ministry in our Franciscan tradition is the best descriptor of a healing mission as I can imagine, and we who work in this ministry are blessed to be able to participate in this mission. All of our employees are part of our system to do well by doing good, and we are continuing to find ways to bring our collective attention to patient-centered care that is safe, effective, efficient, timely and equitable. It is a deep honor and privilege for me to be a part of this community of servant-leaders and to make whatever contribution I can to further its mission and values.”

Dr. Sparks and his wife have lived in downtown Chicago for the past 10 years and are active in neighborhood and charitable organizations and functions.

St. Elizabeth Regional Health, Humana reach contract for in-network health benefits

LAFAYETTE, Ind. — Humana and St. Elizabeth Regional Health have reached a new contract that will provide in-network health care benefits for 164,000 Humana of Indiana members at Sisters of St. Francis Health Services facilities beginning October 2008.

St. Elizabeth Regional Health had been out of Humana’s network since June 2007. The new contract affects all Humana groups; individual and Medicare plan members.

“This agreement enables us to provide the same top-quality care to Humana members that we do to all those we currently serve at our hospitals and practice groups,” said Kevin Leahy, SSFHS president and chief executive officer.

“The addition of St. Elizabeth Regional Health to our hospital network brings to our members one of the country’s premier health systems,” said Humana of Indiana President Veronica Martin. “This agreement reinforces Humana’s commitment to health care provider choice for our members and the collaborative approach both organizations embraced as we worked toward an agreement should be a model for provider/payer relationships.”

The following facilities will join the Humana network:

• St. Elizabeth Medical Center (Lafayette)
• Home Hospital (Lafayette)
• St. Clare Medical Center (Crawfordsville)
• St. Francis Hospital & Health Center (Indianapolis)
• St. Francis Hospital & Health Center (Beech Grove)
• St. Francis Hospital & Health Center (Mooresville)

Humana members with questions should contact Humana’s Customer Service Center at the toll free number on their member ID cards. A full listing of Humana network participating hospitals is also available at www.humana.com.

About St. Elizabeth Regional Health

St. Elizabeth Regional Health includes St. Elizabeth Medical Center and Home Hospital in Lafayette, Sigma Medical Group, Woman’s Clinic and Lafayette OB/GYN. St. Elizabeth Regional Health and is part of a network of 13 hospital campuses in Indiana and Illinois owned and operated by the Sisters of St. Francis Health Services Inc., one of the largest health care systems in Indiana. St. Elizabeth Regional Health, combined with St. Clare Medical Center in Crawfordsville, form the Western Indiana Region of the Sisters of St. Francis Health Services. For more information, go to www.ste.org.