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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Going into 2021, Amwell faces a decidedly different world than it did last year. The telehealth company, which went public in September, will navigate a new set of expectations for virtual care under a new administration.

Most providers saw a surge in virtual visits during the pandemic, and the Boston-based company was no exception. Between January and September, the company saw more than 4.3 million virtual visits, and its revenue was up 78% from the prior year, according to documents filed with the SEC.

Now, with the new Biden Administration, industry groups are watching for future policy changes that could make it easier for patients to receive care in the home and other settings.

Amwell CEO Dr. Roy Schoenberg shared what he’s watching and what’s next for the company in an interview on Wednesday with MedCity News. This interview has been edited for length and clarity.

MedCity: Last year, many people accessed telehealth visits for the first time. What else has changed as you move into the new year?

Schoenberg: Walking into 2020, telehealth was one thing in everyone’s mind. It was the ability to use technology on your phone, on your browser, to quickly get in front of a physician to help you with treatment of the flu, or something really basic.

Coming out of 2020 … everybody’s understanding of what telehealth is has changed fairly dramatically.

Don’t get me wrong, the notion that telehealth can bring convenient access to clinical services, like urgent care and maybe behavioral health remains. It’s not going away. It has incredible value, that’s what we do, that’s what Teladoc does, that’s what Doctor on Demand and some of the others are doing.

But the actual interest and excitement around telehealth has shifted into an area that historically people didn’t think about. How can telehealth operate within the existing relationships between patients and their clinicians? … How can hospitals and delivery networks use telehealth in order to differently envelope the patients they care for regularly, the cancer patients, the heart failure patients, the hypertension patients, those that require frequent interaction with the healthcare system?

MedCity: What is needed for that to continue to grow in the future, such as reimbursement changes or adoption by providers?

Schoenberg: There’s no question that some of the elements that were historically challenging for telehealth will continue to be a part. Reimbursement policy is going to continue to be there — that’s never going to go away.

We have advanced probably a decade in our understanding of how to pay for telehealth in just one year, so we’re in a much better place than we ever were. … Yet when you start using telehealth as a new way in which healthcare relationships take place, there are new pieces to the puzzle that now have to be aligned. It’s not only the payment structure that has to change.

It’s also a new understanding of what is the frequency in which healthcare and a patient need to interact in a world where we can actually check up on their phone for a couple of minutes. How do we change the way we look at how we support cancer patients at home who are living for sometimes months and years with the realities of chemotherapy? How do we reimagine our availability as healthcare professionals to them on a daily basis when they struggle with that condition?

MedCity: Have you gotten any indication of what will be the Biden Administration’s approach to telehealth?

Schoenberg: Many of the folks that are involved or have been brought into the workforces of the administration are people we know or who are very involved in policymaking, thinking, and the taskforces about telehealth that were convened in 2020.

I’m very encouraged by some of the picks that were made and some of the statements that were made about how we can modernize care delivery, and how we should for example recognize the home as a point of care, as a place where healthcare can happen.

MedCity: What policy changes are you watching for?

Schoenberg: There are things that are almost self-evident: recognizing the home as a valid place of care … changing some of the Medicare rules around reimbursement, changing HIPAA rules to accommodate the fact that care is rendered outside facilities and hospitals. Those things I think are not only needed but are also anticipated.

The part that I would say is more aspirational and incredibly important is that notion around state licensure. … The Internet doesn’t stop at the state line. Nothing that we do over online services drops dead when it gets to the state border. Yet in healthcare it does. Because a clinician cannot deliver services to patients who happen to be 10 miles across the border in another state, which absolutely makes no sense.

We have got to create an exception to state licensure when it comes to telehealth-based services. That’s not an easy thing to do.

Photo credit: elenabs, Getty Images 

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EverCommerce, which provides marketing, business management and customer retention solutions to businesses in the service sector, has purchased Updox, a healthcare communication platform for both in-person and virtual care.

Updox will join EverCommerce’s portfolio of health services companies and solutions, which includes cloud-based medical billing, specialty EHR, practice management and revenue cycle management software for healthcare practices. Terms of the deal were not disclosed.

Updox provides virtual care, patient engagement and office productivity solutions for an array of healthcare providers, including physician practices, health systems and post-acute care facilities.

“Updox offers a single, consolidated inbox for providers to manage the entire patient journey and office workflow through solutions like video chat, secure text, and electronic fax and forms that work together to reduce costs and drive revenue,” Mike Morgan, president of Updox, said in an email interview.

The company plans to add new solutions next year.

“In an environment of unprecedented healthcare challenges, we are excited for our two organizations to join forces,” said Matt Feierstein, president and COO of EverCommerce, in a press release. “As a market leader, Updox provides a full suite of differentiated office productivity and virtual care solutions that a practice needs to thrive in today’s healthcare landscape.”

Updox serves more than 560,000 users. It has facilitated over 3.5 million telehealth visits since March and supports more than 15,000 visits per day, according to the press release. The company also recently released a Covid-19 Vaccine Communications Package, which includes secure text, broadcast messaging and electronic forms solutions for providers to help them communicate updates on vaccine availability, appointment details as well as answer patient questions.

Healthcare consumerism has been on the rise for many years. But it gained a significant push forward in 2020, when amid the Covid-19 pandemic, demand for virtual visits and contactless access to providers soared. A recent report, from patient access solutions provider Kyruus, found that 43% of healthcare consumers ranked online scheduling as very or extremely important, and another 42% ranked virtual visits the same. In addition, 49% of millennials and 53% of individuals from Generation X reported they would switch providers to be able to access virtual care.

Further, 58% of healthcare consumers are likely to use telehealth or virtual visits for future healthcare needs, and 74% are now likely to use online chat or texting to provide check-in information before their appointment, according to an Accenture report published last month.

“The market was already moving towards consumerism and value-based care, but Covid-19 accelerated the need for virtual care,” Morgan said. “Now, it’s no longer a novelty — it is a requirement to stay in business.”

“Looking ahead, providers must expand their offerings to include a mix of in-person and virtual visits and engage patients effectively both in and outside the office,” he added. “In doing so, physicians can ultimately be more productive, engage with a larger number of patients and run a highly profitable practice. Updox’s focus on virtual health, patient engagement and paperless office efficiency supports this need.”

Photo credit: LDProd, Getty Images

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As the Covid-19 pandemic continues to rage across the country, it has complicated care delivery in a myriad of ways. In particular, it has stymied efforts to provide chronic disease care for disadvantaged populations. But health systems, like Philadelphia-based Jefferson Health, are not giving up — rather, they are using technology to care for these patients outside of clinics and hospitals.

This summer, Jefferson Health received a service grant from the Federal Communications Commission to aid chronic disease management in underserved communities, Dr. Kristin Rising, an emergency medicine physician and director of acute care transitions at Jefferson, said in a phone call. The system received just under $1 million, which was used to cover the cost of remote monitoring devices for patients, enabling them to engage in telehealth and safely manage their chronic diseases outside of the healthcare setting.

Jefferson has since purchased iPads (with data service for six months), as well as Bluetooth-enabled devices, such as blood pressure cuffs and scales, which can transmit data directly to platforms used by health system providers. The devices are mostly being used by patients with diabetes and cardiovascular disease.

“We have purchased thousands of these devices to distribute to patients across the Jefferson enterprise who are determined by various parameters to be particularly at-risk and underserved,” Rising said. “And to help in their chronic disease management during the pandemic from home.”

Rising organized what she calls a digital on-boarding task force, comprised solely of master’s in public health students from Jefferson’s college of population health. These students volunteered their time to help patients set up their devices and answer any questions they may have.

The pandemic has also created hurdles for research examining interventions to better support chronic disease patients at Jefferson.

In 2019, Rising started a clinical trial examining whether individual nutrition counseling provided via telehealth, along with delivering medically tailored meals to patients’ homes, can improve blood sugar control among diabetics. Rising and her research team won a $3.2 million National Institutes of Health grant to conduct the trial, which aims to enroll 600 patients with uncontrolled diabetes.

The plan was to enroll patients when they came to the hospital for care. Rising’s team would approach patients in the emergency department, assess their eligibility and get their consent before enrolling them. But then, the Covid-19 pandemic hit.

“The biggest challenge, which overshadows any other challenge we might have had in set up, was Covid,” Rising said.

The team was forced to halt enrollment and rethink their plans to ensure they could safely continue, she added. They set up a process for gathering patient data and consent remotely, drawing on the electronic infrastructure already set up at Jefferson. As the pandemic progressed, a hybrid model was adopted, with some patients being enrolled in-person and others virtually. This has allowed the team to return to pre-Covid targets for enrollment. The trial recently enrolled its 100th patient.

Though she cannot provide specifics as the study is ongoing, Rising said that the clinical trial has seen strong participation so far.

“People look at telehealth in underserved populations and worry that it’s not the solution for them — or they are not going to have access, they are not going to be able to use it,” she said. “But I think when we can be thoughtful about thinking out approaches, proactively addressing some barriers the populations may be facing, then telehealth really is a valuable tool for us to be doing chronic disease management.”

Photo credit: Venimo, Getty Images

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