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Virtual Care Key to Humana-Mercy Value-Based Contract

Analysis  |  By Mandy Roth  
   February 25, 2021

Medicare Advantage contract between Humana and Mercy expands to offer patients access to Mercy Virtual services. The arrangement is part of Humana's expanding focus on value-based contracts. 

To improve the health status of its members and reduce the total cost of care, virtual care will become a pivotal component of a Medicare Advantage value-based contract between Louisville, Kentucky-based insurance company Humana and St. Louis, Missouri-based Mercy health system. 

The contract, which is already in effect, now provides in-network access to Mercy Virtual, which offers 24/7 telemedicine services. The center is staffed with more than 300 clinicians and includes virtual primary care.

The initiative covers Humana Medicare Advantage members who are patients of more than 4,000 of Mercy's integrated primary and specialty care clinicians in Arkansas, Kansas, Missouri, and Oklahoma. It expands upon the existing network contract between the payer and provider, which continues to provide in-network access to all Mercy hospitals, outpatient facilities, and physician practices.

This initiative is part of a "broader, joint effort to provide more holistic care to Humana Medicare Advantage members," according to a news release, and helps meet the challenges presented by the COVID-19 pandemic.

In the value-based arrangement, "Payment to Mercy physicians is linked to providing quality care in order to improve the patient experience and health outcomes," according to a news release. This approach provides different incentives than fee-for service models that reward clinicians for the quantity of their patient encounters.

“Mercy is committed to working with our communities to improve healthcare, while also reducing the total cost of care,” said Shannon Sock, Mercy executive vice president, chief strategist, and chief financial officer.

Humana is expanding its focus on value-based care, according to the release. "As of Dec. 31, 2020, Humana has more than 2.7 million individual Medicare Advantage and commercial members who are cared for by more than 67,000 primary care physicians in more than 1,000 value-based relationships across 43 states and Puerto Rico." As of January 2021, Humana’s total Medicare Advantage membership is more than 4.8 million members, including those in value-based arrangements.

“Mercy is committed to working with our communities to improve healthcare, while also reducing the total cost of care.”

Mandy Roth is the innovations editor at HealthLeaders.

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