Finance
After cyberattack, Minnesota health care groups struggling with UnitedHealth financial aid
Emily Benson can see UnitedHealth Group’s headquarters from her office in Edina, but this close proximity hasn’t made it easy for her clinic to find emergency funding from the company.
Benson’s mental health practice submits bills through a UnitedHealth Group subsidiary that shut down its systems more than three weeks ago because of a cyberattack.
That’s left Benson and eight other therapists at Beginnings and Beyond Counseling with basically no revenue and reliant on a $40,000 loan she took out this month from UnitedHealth.
She resorted to this financing, which includes a $780 fee, because the company’s initial no-fee assistance program following the hack offered just $1,100 per week — a small fraction of the clinic’s claims total.
“They’re offering us money, but it’s such an insubstantial amount — such an unhelpful amount,” Benson said, while stressing that she values her relationship with both UnitedHealth and its beneficiaries. “I want to be honest about how much we’re struggling.”
Beginnings and Beyond is one of three Minnesota health care providers that told the Star Tribune this week they haven’t been able to use UnitedHealth’s financial aid programs to fully bridge a cash crunch that’s hitting thousands of hospitals and clinics across the country.
The cyberattack targeted Change Healthcare, a UnitedHealth subsidiary that runs a widely used clearinghouse for electronic claims data that processes 15 billion health care transactions annually and is involved in one out of every three patient records in the U.S. UnitedHealth Group is cooperating with a federal investigation into the cyberattack while scrambling to restore Change Healthcare systems that it shut down to contain the threat.
By week’s end, there were some signs of improvement for providers seeking financial help after the Star Tribune contacted Minnetonka-based UnitedHealth about all three situations.
For two small independent clinics in the Twin Cities, a UnitedHealth temporary assistance program launched March 1 evaluated need based on an assessment of historical claims that was far from complete. As a result, the sums offered were paltry compared with the need — a mismatch that has been reported in recent weeks by some other health care providers in Minnesota and across the country.
“We didn’t even bother to apply,” said Gretchen Moen, clinical director at Dakota Child and Family Clinic in Burnsville.
Late last week, UnitedHealth launched a new “last resort” funding program that’s designed to provide more help, particularly for small and regional health care providers.
“We are currently engaged with several thousand provider organizations to help them with their cash flow challenges, from large regional health systems to small, rural independent physician practices,” UnitedHealth said Friday in a statement to the Star Tribune.
At Robbinsdale-based North Memorial Health, where hundreds of millions of dollars worth of claims are in limbo, negotiations over financial assistance have been ongoing.
“The amounts offered … have been insufficient to resume normal cashflow operations,” the health system said in a Tuesday statement.
On Thursday, North Memorial added: “The conversations are fluid; we are hopeful for short-term, temporary resolution in the days ahead.”
The frustrations voiced publicly by some small clinics, and privately by some large health systems, reflect UnitedHealth’s challenge of quickly standing up assistance programs for the subset of health care providers that have been profoundly impacted. This includes health care providers and insurers that used on an exclusive basis the claims processing clearinghouse from Change Healthcare.
After the American Hospital Association slammed the company’s initial assistance program as insufficient, UnitedHealth responded March 7 with improvements including the last-resort funding mechanism, which offers help on a case-by-case basis for health care groups with no other options.
“We are determined to make things right as fast as possible,” UnitedHealth Group chief executive Andrew Witty said in a statement.
Amy Tannahill, a nurse practitioner with the Rosenberg Center in Roseville, said UnitedHealth’s initial program offered her practice a loan of just $90 per week — an amount she called “ridiculous,” since it wouldn’t even cover the cost of one standard office visit.
In lieu of the UnitedHealth offer, Tannahill and her fellow clinic owners are considering everything from dipping into personal savings to finding a lender that can provide more help. Closing temporarily is one option, but Tannahill says the clinic feels an obligation to keep taking care of patients.
Rosenberg Center offers services for children with developmental and behavioral needs.
“I would like to see [United] take serious ownership of this issue and advance payments immediately [for] providers and support staff who deserve to be paid for their work,” Tannahill said Tuesday via email. “This seems reasonable given that [United] had a profit of $22 billion last year.”
On Thursday, Rosenberg Center received a call from UnitedHealth offering more help.
“I told the rep that we have approximately $170,000 in claims and requested that amount,” clinic manager Mary Thissen Thompson wrote in an email Friday. “He took the information and said if it was approved we would see it … within five days.”
She added: “We would be completely shocked if they came through with that amount.”
At Beginnings and Beyond Counseling, Benson said her UnitedHealth representative contacted her Thursday about a $40,000 no-interest loan. She mentioned how she’d already borrowed that amount from a UnitedHealth loan program that’s been available for many years.
“I asked him to waive the [$780] fee I’m being charged for it in lieu of his offer. He said he’d have to escalate that request,” Benson said via email.
Benson’s first loan will only go so far. Another company representative on Thursday encouraged her to also apply for help through the new last-resort program, Benson said, but she provided a screenshot to the Star Tribune of the “Something went wrong” messages she received Friday morning when trying to do so.
“The page kept rejecting my request,” she said. “I tried three times.”
Some health care providers don’t have much patience for snags because they’ve already invested so much energy in recent weeks trying to use the claims submission “workarounds” that UnitedHealth has been touting.
Revenue at Benson’s practice has gone from about $70,000 per month to “basically zero,” because her health record system relies exclusively on the Change Healthcare clearinghouse for submitting bills. UnitedHealth Group has encouraged practices like hers to use alternate systems, but Benson says they aren’t viable.
She would have to download information on each patient visit and then submit data through a combination of electronic and manual steps depending on the health insurer. Benson tried doing this and found the process for submitting just one claim took about six to seven minutes.
“I’m a single mom with eight practitioners. It’s not feasible for me to do that,” she said. “I don’t have an administrative staff because I’m too small.”
An even bigger problem, she said, is that once the Change Healthcare system is restored, claims submitted through a workaround could trigger her health record to send a duplicate bill to patients for what they owe in cost-sharing. For now, Benson is not submitting any claims, saying she’ll wait for Change systems to resume, even though patients might then receive multiple bills for their cost-sharing all at once.
“We had to send out a letter to everybody we serve, which is about 250 clients, saying: ‘Hey, this is what’s happening right now, please be prepared for really large bills once this gets resolved because we’re not going to be able to stagger your payments,’” she said.
At North Memorial, the Change shutdown effectively halted all claims submissions and many electronic payments to the health system, said Nate Dell, the vice president of revenue cycle management.
Some funds are arriving based on claims submitted before the Feb. 20 attack, but this revenue is “declining precipitously,” Dell said.
“We’re sitting on hundreds of millions of dollars in unbilled accounts receivable,” he said in an interview last week.
Those bills carry values that are significantly larger than the sums that ultimately get paid, since insurers negotiate steep discounts off health system charges.
At North Memorial, patient care generates about $18 million in revenue per week. Financial reserves at the end of last year exceeded $300 million, according to a Star Tribune review of financial statements.
Even so, Dell said the systems outage has been “tremendously disruptive” for the health system, which employs about 5,000 people across two hospitals, more than a dozen clinics and a large EMS service.
“This is a hundred-year storm that no one plans for — that you can’t really insure yourself against,” he said.
Finance
Board Advances Motion to Address LAHSA’s Failure to Pay Service Providers – Supervisor Lindsey P. Horvath
Board Advances Motion to Address LAHSA’s Failure to Pay Service Providers
Board Advances Motion to Address LAHSA’s Failure to Pay Service Providers
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Supervisor Lindsey P. Horvath
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Finance
How “impact accounting” can integrate sustainability with finance
Around three years ago, Charles Giancarlo, CEO of data platform Pure Storage, came back from Davos and asked his sustainability team to look into an idea he’d encountered at the meeting: Impact accounting, a method for integrating emissions and other externalities into company balance sheets.
The idea had been slowly picking up adherents in Europe for around a decade, but Pure Storage, which rebranded this month to Everpure, would go on to become the first U.S. company to join the Value Balancing Alliance (VBA), a group of 30 or so companies developing the approach. Trellis checked in last week with Everpure and the VBA for an update.
How does impact accounting work?
At the heart of the approach are a set of “valuation factors,” developed by third-party experts, that are used to convert activity data for emissions, water use, air pollution and other externalities into dollar figures that can be integrated into balance sheets. In the case of emissions, for example, the VBA uses $220 per ton of carbon dioxide equivalent, a figure based on the estimated social impact of rising greenhouse gases levels.
At Everpure, one long-term goal is to have cost centers be aware of the dollar impact of relevant externalities. After an initial focus on identifying and collecting the most material data, the team is now rolling out a dashboard containing several years of impact accounting numbers.
“It’s catered to different personas,” explained Adrienne Uphoff, Everpure’s ESG regulations and impact accounting manager. Finance was an initial use case, with product managers also on the roadmap. “You can compare it to financial numbers to really understand the impact intensity.”
What value does the approach bring?
“The essence of impact accounting is that you’re translating all these different metrics in the sustainability space into the language the decision makers understand,” said Christian Heller, the VBA’s CEO. “Everyone understands what you’re talking about, and you get a sense of the magnitude of your impact and the risks and opportunities.”
This has allowed Everpure to calculate what Uphoff called the “environmental costs of goods sold” and to estimate the impact of circular strategies, such as refurbishing hardware. The analysis reveals “impact savings across the full value chain across five different environmental topics all in a single dollar unit,” she said.
Analyses like that can then be shared with customers and used to distinguish Everpure from competitors. “The long-term winners in this space are going to be those that can perform against sustainability goals,” said Kathy Mulvany, Everpure’s global head of sustainability. “Impact accounting gives us a way to bring comparability, so companies can understand how they’re truly stacking up.”
What does it take to implement impact accounting?
A great deal of technical work goes into creating valuation factors, but the system is designed so that outside experts create the numbers and hand them to sustainability professionals for use. Still, not every company will have the in-house environmental data that is also needed. Many companies have been collecting emissions data for five years or more, for example, but detailed datasets for water use are less common.
Internal teams also need to be familiar with the concepts. “One of the key learnings from our impact accounting implementation is that the socialization curve is longer than you expect,” said Uphoff. “Attaching monetary values on externalities introduces new metrics and mental models, and that can naturally make people a little nervous at first. It takes time and dialogue for teams to build confidence in how to interpret this new lens on performance.”
What’s next?
In the early days of impact accounting, companies and consultancies worked independently on different methodologies. Now that work is coalescing, said Heller. The International Standards Organization will start work on a standard this summer, he added, and the VBA is having conversations with the IFRS Foundation, which creates international financial reporting standards.
The approach may also be integrated into mandatory disclosure standards. Heller noted that the European Union’s Corporate Sustainability Reporting Directive mentions the potential benefits of companies putting a dollar figure on some environmental impacts. “It’s the next evolutionary step of any kind of sustainability disclosure regulations,” he said.
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Finance
2 Aspira charter high schools to close by April due to financial issues
Chicago Public Schools is shutting down two Aspira charter high schools by the middle of the year, following financial issues over the past year.
School leaders are calling the move “unprecedented.”
Students at the Aspira Business and Finance High School at 2989 N. Milwaukee Ave. in Avondale held a walkout right outside of Aspira after the CEO said they only have enough money to stay open for the next four to five weeks.
Students wanted their questions answered as to why they’re being transferred to other schools.
Angelina Mota is a senior at the high school and said she is concerned about her future.
“It’s very difficult, especially for us, hearing that credits might not go all the way with us. That our graduation might just be taken back. It’s very disappointing,” she said.
This is the first time a CPS school will close before the end of the school year. Both Aspira and CPS said the charter network won’t have the funds to stay open past April.
“The burden on our seniors has got to be… they don’t give a damn about the kids. The seniors,” Aspira of Illinois CEO Edgar Lopez said while fighting back his emotions.
The school is facing a $2.9 million deficit, impacting 540 students and dozens of staff.
CPS said they have already given more than $2.5 million to the charter school to help sustain operations. They said under Illinois law, it reached the legal limit of funding it can provide.
This has been a year-long effort in compliance with state charter school law.
In a statement, CPS said, “Aspira has not submitted required documentation, including evidence of funding to support operations through this school year.”
The documents CPS said are overdue include the school’s fiscal year 25 financial audit, general ledger, and payroll.
“We’re not hiding nothing. The financial documents that they were asking for, Jose told them, we’ll have them to you by Friday. Then they send a letter by Thursday. They didn’t even give us a chance,” Lopez said.
CPS said they’re initiating this due to the lack of financial transparency and solvency.
“We know we don’t want to go anywhere else because we’re used to the routine we have here,” said student Arichely Molina.
“Please let us (stay) open. at least until we graduate,” Mota said.
CPS said their main goal is to ensure the kids have a safety net as they transition to another school.
The second school is located at 3986 W. Barry Ave., also in the Avondale neighborhood.
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