ST. LOUIS (Nov. 19, 2024) – Mercy is proving high quality care that aims to keep patients healthy and out of the hospital is an effective way to save money for everyone involved in the health care industry. Newly released results from the Centers for Medicare & Medicaid Services (CMS) ranks Mercy No. 6 nationally in quality among the 20 largest Accountable Care Organizations (ACO) and the fourth highest taxpayer savings among all ACOs serving Medicare patients.
CMS tracks more than 30 quality measures focused on care coordination, patient safety, appropriate use of preventive health services, improved care for at-risk populations and patient and caregiver experience of care.
“Putting the patient first, making sure their needs are met and coordinating their care keep patients healthier and happier,” said Dr. Gavin Helton, Mercy president of primary care. “When we do that, quality scores reflect the outstanding care we provide.”
This patient-centered approach to keep patients healthy helps lower costs and can make health care in the U.S. sustainable. For 2023, Mercy’s ACO saved taxpayers $95.5 million, an increase of $12 million from the previous year ‒ the fourth largest savings in the country while serving the ninth most Medicare members.
Over the last six years, Mercy’s ACO has saved taxpayers $359.9 million dollars.
“Our focus on preventative care and keeping patients healthy translates across the board to every population we serve,” said Steve Mackin, Mercy president and CEO. “It is proving effective for our Medicare patients year after year. Working with all payers, including those in the commercial insurance market, to streamline care, eliminate red-tape and prevent illness in this manner is beneficial for patients in every age group, payers and health care providers and is the way we must work in order to keep health care sustainable.”
Mercy physicians were among the first in the nation more than a decade ago to voluntarily participate in an ACO to better coordinate care for Medicare patients while eliminating unnecessary costs. To become an ACO and maintain the designation, Mercy has to score high on specific quality measures and prove that its medical providers sustain streamlined team-based care.
Mercy, one of the 20 largest U.S. health systems and named the top large system in the U.S. for excellent patient experience by NRC Health, serves millions annually with nationally recognized care and one of the nation’s largest and highest performing Accountable Care Organizations in quality and cost. Mercy is a highly integrated, multi-state health care system including more than 50 acute care and specialty (heart, children’s, orthopedic and rehab) hospitals, convenient and urgent care locations, imaging centers and pharmacies. Mercy has over 900 physician practice locations and outpatient facilities, more than 4,500 physicians and advanced practitioners and 50,000 co-workers serving patients and families across Arkansas, Kansas, Missouri and Oklahoma. Mercy also has clinics, outpatient services and outreach ministries in Arkansas, Louisiana, Mississippi and Texas. In fiscal year 2023 alone, Mercy provided more than half a billion dollars of free care and other community benefits, including traditional charity care and unreimbursed Medicaid.
Mercy’s Southeast Missouri Hospital College of Nursing and Health Sciences is welcoming its first class of Win From Within students. These students are all co-workers at Mercy Southeast who receive tuition assistance from Mercy.
Win From Within students work at Mercy Hospital Southeast as patient care associates, nurse technicians or in non-clinical support roles as paid, part-time co-workers while attending the college’s nursing or health sciences program. Students ultimately transition into a clinical health care role in their respective field at Mercy Southeast after graduation.
“The up-front cost of going to school can be a huge factor,” said Katie Finder, Mercy Southeast chief nursing officer. “This program is a win for us and the college. We’re able to fill vacant roles while at the same time boost enrollment at the college and help these co-workers further their health care education. There’s no out-of-pocket cost to them, and we have the peace of mind to know they will stay with us after graduation.”
The program is offered at other Mercy hospitals and schools, but this is the first group through Mercy’s Southeast Missouri Hospital College of Nursing and Health Sciences. To mark the occasion, Mercy Southeast recently held a signing dinner for its caregivers taking part in the program, similar to events held when student-athletes sign with colleges.
“Historically, alumni from Southeast Missouri Hospital College of Nursing and Health Sciences remain in the area,” said Amy Beussink, associate of applied science program director at the college. “Mercy’s introduction of the Win From Within program is innovative and supports the need for health care workers in the Southeast Missouri area and other Mercy communities. We are excited to introduce Win From Within to our students and to get the word out to the community. This program helps reduce financial barriers for those seeking a health care education and fulfills the mission of the college to respond to the health care educational needs of the region by preparing qualified health care professionals.”
The program is open to any Mercy co-worker interested in pursuing a nursing or health sciences degree, even new hires. Mercy pays up to $10,000 per year for eligible expenses, paid directly to the school for up to three years. Students must be enrolled in a nursing or health sciences program at a qualifying school such as Mercy’s Southeast Missouri Hospital College of Nursing and Health Sciences, must work a minimum of 16 hours every two weeks and sign a contract that states they will remain with Mercy after graduation for one year for each year of program participation.
The first class of Win from Within students recently participated in a signing dinner at Mercy Hospital Southeast, similar to events held when student-athletes sign with colleges, to show their commitment to Mercy’s Southeast Missouri Hospital College of Nursing and Health Sciences. Students are pictured here with leadership teams from the college and Mercy Hospital Southeast.
Mercy, one of the 20 largest U.S. health systems and named the top large system in the U.S. for excellent patient experience by NRC Health, serves millions annually with nationally recognized care and one of the nation’s largest and highest performing Accountable Care Organizations in quality and cost. Mercy is a highly integrated, multi-state health care system including more than 50 acute care and specialty (heart, children’s, orthopedic and rehab) hospitals, convenient and urgent care locations, imaging centers and pharmacies. Mercy has over 900 physician practice locations and outpatient facilities, more than 4,500 physicians and advanced practitioners and 50,000 co-workers serving patients and families across Arkansas, Kansas, Missouri and Oklahoma. Mercy also has clinics, outpatient services and outreach ministries in Arkansas, Louisiana, Mississippi and Texas. In fiscal year 2023 alone, Mercy provided more than half a billion dollars of free care and other community benefits, including traditional charity care and unreimbursed Medicaid.
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Mercy’s Commitment to Southeast Missouri Patients At Mercy, our priority has always been the well-being of our patients and their families. We truly believe that we have a duty to advocate for our patients and co-workers to continue our long history of delivering high-quality care at the lowest average cost. As we negotiate with Anthem Blue Cross Blue |
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Shield to secure a mutually beneficial agreement that will improve the patient experience, we want to ensure that the facts are clear and that our communities in Stoddard County and beyond understand why these negotiations matter. |
Why We Are Negotiating
Mercy is dedicated to providing high-quality, accessible health care to the people of Missouri, and we’ve worked hard over the past year to reach an agreement with Anthem that allows us to continue doing so. Unfortunately, despite months of negotiations, Anthem has consistently presented terms that undermine our ability to deliver the care our patients need.
Contrary to what Anthem suggests, this is about more than financial terms — it’s about ensuring our patients have uninterrupted access to comprehensive, compassionate care in a timely manner without the red tape and barriers put into place by Anthem. Though Mercy’s costs, like those of every health care provider, have risen due to factors outside of our control, such as inflation and labor shortages, we are simply asking for a contract that reflects the realities of today’s health care landscape.
Addressing Misinformation
Mercy is not demanding drastic rate hikes, as Anthem’s statements have claimed. We are seeking fair reimbursement that enables us to continue providing high-quality care without placing undue financial pressure on our system, the employers who rely on us and patients and families in Southeast Missouri who choose us for their health care. Anthem’s characterization of our proposals does not align with the facts. In the St. Louis region, according to payer transparency files, Mercy is currently 22% less expensive on average than other providers. Having Mercy in your network helps keep costs down, without us, costs will go up.
It’s also important to address the claim that we are jeopardizing access for Medicaid and Medicare Advantage members. Mercy has been a steadfast provider of care to vulnerable populations for decades, and this commitment will not change. We remain focused on serving all members of our community, regardless of their insurance status or financial circumstances. Each year, Mercy provides about a half billion dollars of care and support to those unable to pay.
Putting Patients and Co-Workers' Care First
The heart of this matter is simple: Mercy is here to care for communities in Southeast Missouri and across the state, and that means advocating for agreements that reflect our mission. Anthem has had the opportunity to step up and work with us to build a contract that supports patients and caregivers alike. Yet, their approach has focused more on protecting shareholder profits than on ensuring frictionless or timely access to essential services for patients.
We are advocating for a deal that addresses systemic issues with Anthem’s practices. Among our patients and co-workers, we have seen the detrimental effects of Anthem’s complex processes, denied claims and delayed approvals. We have heard from a number of our patients who have voiced concerns on how tests and procedures ordered by their health care provider are repeatedly denied; even instances when a covered claim was paid and then retracted, leaving the patient on the hook. For health care co-workers, Anthem is creating barriers to care by placing unnecessary administrative burdens on them, which leads to increased costs for patients, delays in receiving necessary care and a negative impact on patient wellbeing.
At Mercy, we’re looking toward the future — investing in virtual care, expanding primary care access and providing solutions to keep patients healthy, not just treat people when they’re sick. This isn’t about individual price points; it’s about creating a system that works for everyone — patients, employers and health care providers alike.
What Happens Next
Mercy will remain in Anthem’s network through the end of 2024, and we will continue to provide our patients with the care they need during this time. If a new agreement is not reached, we will do everything possible to ensure smooth transitions for all our patients.
We hope that Anthem will continue to be at the table with us, prepared to negotiate in a way that reflects our shared responsibility to our community. In the end, we believe that putting patients first should guide these discussions, and we remain committed to making that happen for Stoddard County and Southeast Missouri.
For more information, please visit mercy.net/anthem.
— Sue Ann Williams, administrator, Mercy Hospital Stoddard
— Eric Ammons, regional president, Mercy Southeast
Mercy Southeast Patients Better Connected with New Electronic Health Record System
Patients of Mercy Southeast now have a single, comprehensive electronic health record to provide more coordinated care. All Mercy caregivers will have access to the new Epic system, which gives patients 24/7 access to their health records through the MyMercy patient portal and MyMercy+ app, to online scheduling through mercy.net and virtual care options.
On Oct. 6, Mercy Hospital Southeast, its clinics and all Mercy services and locations in the Cape Girardeau area transitioned to Epic, software designed to provide high-quality, personalized results for both patients and Mercy co-workers. This state-of-the-art system provides one patient health record available to all Mercy health care providers at all Mercy locations. The transition to Epic includes the Mercy Computing Mobile Platform, which gives key caregivers mobile capability.
The changeover fully integrates Mercy Southeast with the rest of the Mercy health system across Missouri, Kansas, Oklahoma and Arkansas, with the exception of Mercy Stoddard, which will transition to Epic’s electronic health record in summer 2025.
“Completing this project is an important, significant investment in the future of health care in Southeast Missouri,” said Eric Ammons, regional president. “Mercy has the most comprehensive electronic health data over time, which is a tremendous benefit to our patients. That depth of data is vital to our physicians, nurses and other caregivers, who can use it to provide proactive, predictive and personalized care for our patients.”
Epic is just one piece of Mercy’s $45 million, multi-year IT investment in adding new technology and tools to assist Mercy’s health care team in combining the newest medical technology with exceptional care across the Southeast Missouri community. Those advancements include numerous virtual care options, digital platforms and convenient access to health care when patients need it.
“Transitioning Mercy Southeast to a new electronic health record was a massive undertaking,” Ammons said. “Over the last year, our Mercy Southeast co-workers, physicians and advanced practice providers spent countless hours ensuring we were ready to make this transition smoothly. With co-workers across Mercy coming to Southeast Missouri to work alongside us, we successfully completed this extremely complex transition. I couldn’t be more proud of the effort of our Mercy Southeast team to help us fulfill our promise to improve access and provide quality care right here where it’s needed.”
All Mercy Southeast services and locations can now be found in one online location: mercy.net, a user-friendly online experience for finding services, doctors, locations and online scheduling throughout Southeast Missouri and the Mercy health system.
Patients will also find advantages of the new MyMercy+, including a free, easy-to-use app that allows anyone – not just Mercy patients – to manage their health online via phone or tablet. Benefits include:
- Viewing future health summaries
- Tracking and reviewing test results
- Messaging care teams
- Access to Mercy Now to find and schedule the most appropriate type of care 24/7
- Requesting prescription refills
- Reviewing and paying bills
- Requesting estimates or financial assistance for care
- Linking health accounts from other health systems
- Real-time alerts for updates about care and new features
- Connecting seamlessly to Wi-Fi to take advantage of all MyMercy+ features
MyMercy+ is available for free download from the Apple Store and Google Play Store.
Mercy, one of the 20 largest U.S. health systems and named the top large system in the U.S. for excellent patient experience by NRC Health, serves millions annually with nationally recognized care and one of the nation’s largest and highest performing Accountable Care Organizations in quality and cost. Mercy is a highly integrated, multi-state health care system including more than 50 acute care and specialty (heart, children’s, orthopedic and rehab) hospitals, convenient and urgent care locations, imaging centers and pharmacies. Mercy has over 900 physician practice locations and outpatient facilities, more than 4,500 physicians and advanced practitioners and 50,000 co-workers serving patients and families across Arkansas, Kansas, Missouri and Oklahoma. Mercy also has clinics, outpatient services and outreach ministries in Arkansas, Louisiana, Mississippi and Texas. In fiscal year 2023 alone, Mercy provided more than half a billion dollars of free care and other community benefits, including traditional charity care and unreimbursed Medicaid.
Anthem should join Mercy in putting patients first
By Steve Mackin
At Mercy, we always advocate for our patients and our co-workers. That is our guiding principle for everything we do. All our work is focused on providing the best patient care.
After nearly a year of discussion and negotiation with Anthem Blue Cross Blue Shield, Mercy had to provide a written notice to end our provider contracts with Anthem in the state of Missouri as of Jan. 1, 2025, due to our 120-day notice requirements. While our dispute with Anthem over these contracts is in part a business dispute, there are principally two key elements of the patient care journey we are seeking to improve: reducing unnecessary red tape to make access to care easier for patients and improving collaboration to create better value for the communities we serve.
Reducing Red Tape
Anthem unfortunately employs a variety of practices that bind patients in red tape. Patients and their care providers must often navigate a series of challenges before Anthem will authorize care. These delays disrupt patient care and, in some cases, can create critical situations.
Anthem’s complex processes also create difficulties for patients after they receive care. For example, we’re required to notify Anthem if one of its members is admitted to one of our emergency departments within 48 hours of admission. If we don’t, Anthem won’t pay for the care. Emergency care, by definition, is unplanned. Not every patient rushed into our emergency departments has their insurance card handy, and the law requires hospitals to provide emergency services before inquiring about insurance. These rules only serve to shift responsibility for payment from Anthem to its patients or to be absorbed by health systems.
As one of our region’s largest employers, we’re proud to offer our employees health insurance benefits. In fact, Mercy pays directly for the care provided to our co-workers and their families—nearly 70,000 people. Anthem has been the administrator for our self-insured plan for nearly a decade. Unfortunately, we have heard loud and clear from our co-workers about their poor experience with Anthem as patients. Because of the negative impacts of Anthem’s policies and practices on our co-workers and their families, we chose to move to a new plan administrator for 2025.
Today, Anthem’s policies and unpredictable enforcement create unnecessary challenges for doctors and cause patients additional worry during some of the most trying experiences of their lives.
Collaborating to Create Value
Anthem also fails our patients—its members—with its lackluster and outdated approach to partnering with health systems like Mercy. Anthem intensely focuses on the price per service. We are advocating for a proactive approach to care that focuses on quality and keeping patients healthy and out of the hospital, as opposed to one that mostly offers sick care. This paradigm shift would drive greater value for patients and employers by creating the opportunity for better outcomes at lower costs.
This is why Mercy has invested so heavily in primary care, virtual care and innovative options that allow patients to receive support without having to come to a hospital. As we advance our care delivery model, Mercy needs collaborative relationships with insurers that put patients first. We seek insurers who recognize that the total cost of care is not just about individual procedural rates, but also the efficient delivery of high-quality care and the ease of access we provide to patients. As a result of this approach, Mercy is the lowest-cost health system in Missouri by a significant amount. In the St. Louis region, Mercy has the lowest commercial pricing by 21% according to the NASHP Hospital Cost Tool.
As a nonprofit health system, Mercy provided more than half a billion dollars in free care in fiscal year 2023 and over $377 million of that care is in Missouri (most recently available data). This free care includes traditional charity care, unreimbursed Medicaid and other community benefits. Mercy’s operating margin for fiscal year 2022 was -0.2% and 0.1% for fiscal year 2023.
Meanwhile, Elevance Health, the corporate parent of Anthem, reported a 24% increase in profits year-over-year for the quarter ended June 30, 2024—a net income of $2.3 billion for the quarter. They also used a portion of their profit to purchase nearly a million shares of their own stock at an average price of $524 a share—dollars that could have been spent helping patients and reducing the cost to employers.
That’s why we’re standing up and asking for changes to the way Anthem does business on behalf of 500,000 Missourians, who are covered by a number of Anthem insurance products and chose Mercy as their care provider.
Our current contract with Anthem does not meet the needs of our patients or co-workers. We’ve tried for a long time to negotiate with Anthem in good faith. We’re ready to get this done today, but we need Anthem to be responsive. We need them to do what’s in the best interest of the people we jointly serve, in the best interest of employers and in the best interest of the state of Missouri.
More information can be found at mercy.net/anthem.
Steve Mackin is president and CEO of Mercy.
