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On the heels of a coordinated care agreement with Anthem, St. Louis-based Mercy is partnering with another health insurer.

On Thursday, the health system announced it was entering into an agreement with Louisville, Kentucky-based Humana to expand patient access to virtual health resources.

Per the new agreement, Humana’s Medicare Advantage members who are patients at Mercy facilities and physician practices will gain in-network access to Mercy Virtual. Staffed with more than 300 clinicians, Mercy Virtual offers 24/7 telehealth services, including virtual primary care at home.

In addition, the agreement links provider reimbursement to quality of care, shifting the payment model for Mercy physicians from fee-for-service to value-based compensation.

“Mercy is committed to working with our communities to improve healthcare while also reducing the total cost of care,” said Shannon Sock, Mercy’s executive vice president, chief strategist and CFO, in a news release. “Strong payer relationships, like this one with Humana, will help in our long-term journey to provide more seamless care for our patients. Together we can make a real difference for patients, which is especially critical during this pandemic.”

The new agreement brings together an insurer with a sizeable membership and a vast healthcare organization.

Mercy includes more than 40 acute care, managed and specialty hospitals, urgent care locations, imaging centers and pharmacies, as well as 4,000 primary and specialty care clinicians in Arkansas, Kansas, Missouri and Oklahoma. And, as of January, Humana’s Medicare Advantage membership totaled more than 4.8 million.

“This agreement unites two organizations striving to offer care that is more accessible, personalized and coordinated — a commitment that is more important than ever right now,” said Jeremy Gaskill, Humana regional Medicare president, in a news release.

The news of the partnership between Humana and Mercy comes just a few weeks after the health system entered into a cooperative care agreement with Anthem. That partnership includes a closer alignment between clinical care and reimbursement as well as increased data flow between Mercy and Anthem.

As the healthcare industry moves toward value-based care, provider-payer partnerships that aim to improve care quality have become more popular.

For example, at the end of last year, Salt Lake City-based Intermountain Healthcare and UnitedHealthcare established an accountable care organization with the goal of improving care coordination and health outcomes for the payer’s Medicare Advantage members. In another instance, Butler Hospital, a mental health facility, partnered with Blue Cross & Blue Shield of Rhode Island to reduce hospital readmissions.

“If either a payer or provider is looking to fill a gap and expand optionality of services for partners or members, these types of innovative partnerships are beneficial because they provide both parties an opportunity to quickly refine and build versus recreating the wheel,” said Nick Donkar, PricewaterhouseCoopers’ health services deals leader. “This strategy enables a win-win solution in short order.”

Provider-payer partnerships will likely continue into the future to help both entities fill gaps as they think about improving care in a virtual environment, he said.

Photo: Gerasimov174, Getty Images

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Just four days before the presidential election, the Trump Administration finalized its long-promised rule requiring insurers to share prices for healthcare services and patient cost-sharing with the public upfront. But payers say the rule will not achieve its aim of lowering prices.

The final rule, released yesterday by CMS, orders healthcare payers and self-insured plans to provide easy-to-understand and personalized information on cost-sharing and to publicly disclose the rates they pay to providers through online tools. Insurers and plans must also make this information available in paper form, if requested.

“Price transparency puts patients in control and forces competition on the basis of cost and quality which can rein in the high cost of care,” said Centers for Medicare & Medicaid Services Administrator Seema Verma in a statement. “CMS’ action represents perhaps the most consequential healthcare reform in the last several decades.”

The rule will provide about 200 million Americans with access to real-time price information, a CMS press release said. The regulation concerning health insurers comes about a year after CMS issued a similar rule requiring hospitals to publicize negotiated rates with insurers beginning in 2021.

But it will be about four years before healthcare consumers in the U.S. gain a full picture of prices from payers. Insurers must disclose negotiated rates and provide personalized estimates of patient out-of-pocket costs for 500 services and items, including drugs and medical equipment, beginning Jan. 1, 2023. Insurers must make that information publicly available for all items and services starting Jan. 1, 2024.

Further, the rule asks insurers to make their data files on healthcare costs available for research purposes. Researchers and technology developers can use the data to create solutions that will help people make healthcare decisions, including tools to compare prices between health plans. Insurers must make these data files public starting Jan. 1, 2022.

America’s Health Insurance Plans, a national payer association, released a statement noting its “disappointment” in the final rule.

The rule “will work to reduce competition and push healthcare prices higher — not lower — for American families, patients, and taxpayers,” the association said. “Competition experts, including the bipartisan Federal Trade Commission, agree that disclosing privately negotiated rates will reduce incentives to offer lower rates, creating a floor — not a ceiling — for the prices that drug makers, providers, and device makers would be willing to accept.”

In addition, the association said that three-quarters of commercial health insurance providers already offer price transparency tools.

Health Care Service Corp. is one of those insurers. The payer, one of the largest in the country, said in an emailed statement that their online tool “allows members to compare costs for over 1,600 healthcare services and understand their potential out-of-pocket expenses and cost-sharing obligations.”

The company is currently reviewing the final rule to determine next steps, including whether any modifications need to be made to the information and tools it currently offers members.

Photo: utah778, Getty images

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