With healthcare costs ballooning and slated to reach the staggering figure of $6 trillion by 2027, providers and payers are joining forces to rein in spending.
The latest provider-payer duo to enter into a collaboration are St. Louis-based Mercy and Anthem Blue Cross and Blue Shield in Missouri. On Tuesday they announced a cooperative care agreement with the aim of improving health outcomes and lowering costs.
The agreement establishes shared goals, data, care delivery processes and incentives between the two organizations, said Shannon Sock, Mercy’s executive vice president of strategy and CFO, in an email.
“The fractured, fee-for-service approach to healthcare delivery of the past has been one contributor to healthcare costs skyrocketing while health outcomes stagnate,” said Sock. “As with all complex societal issues, the key to optimizing our healthcare system is cooperation.”
The new agreement builds on an earlier collaboration between Mercy and Anthem, which involves Mercy’s participation in Anthem’s Enhanced Personal Health Care program.
That Anthem program is a value-based care reimbursement model that measures and financially rewards improved health results and efficiency, said Amadou Yattassaye, president of Anthem Blue Cross and Blue Shield in Missouri, in an email.
The cooperative care agreement goes one step further by incorporating activities to improve patient experience, increase data flow between Mercy and Anthem and more fully align financial incentives, Yattassaye said.
This includes implementing 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.”
To achieve its health outcomes and patient experience goals, Mercy will promote digital access to primary and specialty care, including patient navigation services, Sock said.
In addition, the health system will commit to specific improved clinical outcomes in emergency department visits, readmission rates and patient safety and complications, among other quality metrics.
Though this level of financial and clinical alignment is still relatively rare in healthcare, it has grown amid the Covid-19 pandemic. For example, last September, 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.
Further, industry experts are anticipating more payer-provider partnerships in 2021. The pandemic has exposed the limitations of fee-for-service payment structures, which may result in more payer-provider partnerships focused on developing new payment and care delivery models, according to a recent Kaufman Hall report.
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