The healthcare cost is rising. The figure is expected to touch $6 trillion by 2027. Some of the providers and payers are joining hands to tackle inflation. St. Louis-based Mercy and Anthem Blue Cross and Shield in Missouri are the latest partners in the same line. In the inked cooperative care agreement, the duo targets to lower the cost while raising the standards for health outcomes and patient experience. Promotion of digital access to primary and specialty care, including patient navigation service will remain the focus. It aims at better synergy between clinical care and reimbursement. To smooth out the various functions, the increased data flow between Mercy and Anthem is also one of the aims.
- According to Shannon Sock, Mercy’s executive vice president of strategy and CFO, the agreement establishes shared goals, data, care delivery processes and incentives between the two organizations. He added that the fractured, fee-for-service approach to healthcare delivery of the past has been one contributor to healthcare costs skyrocketing while health outcomes stagnate. He called the cooperation key the key to optimizing our healthcare system is cooperation.”
- New agreement has been built upon a previous partnership between the two that focused on Mercy’s participation in Anthem’s Enhanced Personal Health Care program. Amadou Yattassaye, president of Anthem Blue Cross and Blue Shield called the Anthem program a value-based care reimbursement model that measures and financially rewards improved health results and efficiency.
- The duo wants to implement innovative care models, like bundled payments programs, to ensure coordination of disease management and healthcare utilization between Anthem and Mercy. Further, payer reimbursement will be closely aligned with both clinical outcomes and patient experience, Yattassaye said. “Mercy has increased the level of financial risk we take on in this new agreement,” said Sock. “It means, now more than ever, Mercy is directly responsible for the total cost of care incurred by a patient and employer.”
- They are also aiming at improving specific improved clinical outcomes in emergency department visits, readmission rates and patient safety and complications, among other quality metrics.
- The trend of forging agreement between payer and provider is catching up amid pandemic. Last year, CareFirst BlueCross BlueShield and Columbia, Maryland-based MedStar Health announced a new value-based care partnership that aims to deliver improved health outcomes and save $400 million over the next seven years. Experts predict more partnerships in 2021.