St. Louis-based Mercy is targeting closer partnerships with fewer organizations, Gavin Helton, MD, president of primary care at the system, told Becker’s.
One of these partnerships is with Humana. Mercy and Humana opened their first collaborative 65Prime+ Clinics in Springfield and Nixa, Mo., in June.
Older adult-focused care makes “all the sense in the world,” Dr. Helton said, but the reimbursement can be a challenge. Changes in Medicare Advantage reimbursement have led to decreased funding, he said.
The headwinds have made it difficult for providers to find the capital to launch new care models, Dr. Helton said, which is where Humana stepped in. Humana operates more than 300 clinics through its CenterWell primary care brand.
“That leaves providers in a situation where it becomes very difficult to create a sustainable, senior-focused care model without this kind of deep partnership like we have with Humana. As we see cost and utilization continuing to climb across the country — the only way to optimize success for the patients is through a highly integrated approach,” Dr. Helton said.
Mercy is planning to open between 10 and 20 65Prime+ Clinics with Humana in the coming years, Dave Thompson, senior vice president, chief growth officer and president of population health at Mercy told Becker’s.
The companies are eyeing a mix of urban and rural markets adjacent to Mercy’s existing footprint in Oklahoma, Missouri, Arkansas and Kansas for new clinics, he said.
While the project is too new for long-term outcomes data, so far, the clinics have been a “wow” experience for both patients and providers, Mr. Thompson said.
“It’s been validating in our journey. What we knew, conceptually, made sense is really coming together for caregivers and patients alike,” he said.
True alignment between payers and providers is a “rare thing,” Mr. Thompson said, and Mercy is targeting similar arrangements in the future.
“That’s going to require us to prioritize other payers. We can’t do this kind of work, and spend this kind of time that’s necessary if other players aren’t coming to the table as well,” he said.
“It’s so important for what we are having to navigate into the future — headwinds in funding, the aging population, and complex patients — we need partners like this to navigate the future of healthcare.”
The ultimate benefit of the partnership is for patients, Dr. Helton said.
“Bringing our data sets together, putting our heads together to create a better care model, with a sustainable reimbursement model — patients are the ultimate winner, and that has to be the goal,” he said.
