Mercy’s top leaders recently gathered in Pittsburgh, Pennsylvania, where the Sisters of Mercy opened their first American hospital in 1847 in a city that did not have one, to honor the beginnings of Mercy in America. Mercy leadership heard from Dan Kueter, CEO of UnitedHealthcare Employer & Individual, about how working together over the next five years can provide greater access and better health care for all.
Mercy leaders regularly make intentional efforts to learn from innovators working to bring evidence-based, high-quality, low-cost health care to all. Kueter is the latest in a series of leaders Mercy has sought out for these discussions, joining leaders from organizations such as Microsoft, Mayo Clinic and Epic in previous years.
“Mercy is always open to new ways to best serve our patients, and by collaborating with these world-class leaders, we provide better health care to the patients we serve and an improved model for others across the U.S.,” said Steve Mackin, Mercy president and CEO. “Mercy is heading into our third century of care. Catherine McAuley founded the Sisters of Mercy in 1827 in Dublin, Ireland, then charged seven Sisters, including Sister Frances Warde, one of the five founding Sisters in Ireland, to voyage to America in 1843 to spread the works of Mercy, both caring for the sick and providing education.”
Exploring New Frontiers and Collaborations
Serving where care is needed has been a Mercy constant. For the Sisters in the 1800s, it was walking into the unknown – new lands, new challenges, uncharted territory − prepared to serve.
Today, it’s operating in a new landscape with fast-paced technology and ever-evolving innovations to better care for everyone.
“Mercy and UnitedHealthcare share a vision to treat people holistically, with a focus on value,” Kueter said. “Together, we have the opportunity to improve health care by reducing administrative intensity, proactively engaging patients in the right care settings and removing friction to ensure timely care for the whole person.”
UnitedHealthcare is currently working to modernize the prior authorization process and simplify the health care experience for consumers and providers. Last year, UnitedHealthcare reduced the number of CPT codes requiring prior authorizations, representing nearly 20% of its total prior authorization volume. This year, it has launched a first-of-its-kind national Gold Card program for provider groups like Mercy that consistently adhere to evidence-based care guidelines. Physicians and advanced practice providers who meet evidence-based care criteria for a variety of procedures and screenings will see a reduction in their total prior authorization request volume.
Providing More Value for Patients
A key concept of value-based medicine is connecting health care payments to the value of the care provided rather than the amount of care provided.
“The traditional fee-for-service approach is a major driver of rising costs and an obstacle for our patients and patients across America in receiving the best care,” Mackin said. “That’s why we’re working with UnitedHealthcare because we have a mutual focus on proactively keeping patients healthy and out of the hospital.”
Value-based care rewards health systems, hospitals, physicians and other providers for delivering what everyone strives for: patients who remain healthy and thriving. As America ages with more people managing serious chronic health conditions there are also projected shortages of needed providers. Technology can help fill the gap by monitoring patients and checking in with them remotely. Long before the government recognized and reimbursed for virtual care, Mercy invested in it knowing it could solve problems of access and more proactively care for people at risk for hospitalization.
“What we’re doing at Mercy enables us to provide high-quality health care at a lower cost to patients, their employers who purchase their health insurance and insurers,” Mackin said. “To do this successfully and grow this approach to the point it becomes the standard, we need more than just buy-in from insurance companies. We need them to share our view on the importance of value-based care and work with us to keep health care sustainable in the U.S.”
“UnitedHealthcare has demonstrated their commitment to patients, enabling them to receive the care they need and to trusting physicians and advanced practice providers who follow evidence-based medicine,” Mackin said. “For those reasons, we recently chose to move our more than 70,000 co-workers and family members on the Mercy co-worker health plan to UnitedHealthcare.”
Kueter shared with Mercy leaders that UnitedHealthcare believes this approach is what’s best for everyone, particularly patients.
“Working hand-in-hand with a health system like Mercy is the right way to meet this goal,” he said. “A value-based approach allows us and Mercy to proactively address health issues and keep people healthy.”
Seeking Innovators
UnitedHealthcare is the most recent example in a series of collaborations where Mercy brings in expertise from outside its own organization to enhance its high-quality patient care. From Mayo Clinic and Epic to Microsoft, Mercy seeks innovation wherever it exists.
“To make great strides forward requires innovation, and the Sisters of Mercy before us were always innovating and challenging the status quo,” Mackin said. “It’s why we’re utilizing the health data Epic offers and working with Mayo Clinic to use data to develop new ways to diagnose, treat and prevent disease. We are also collaborating with Microsoft to turn the power of generative AI into advanced digital technology to deliver better care. It’s how we live the legacy of the Sisters of Mercy. Just as the Sisters walked into an unknown future, across oceans, leaving behind the familiar, we do too.”
When the Sisters first came to America, innovation was opening a hospital in a city where a hospital never stood before. That innovation stands today as UPMC Mercy Hospital in Pittsburgh. Although it isn’t affiliated with Missouri-based Mercy, it’s a fitting reminder of what seven Sisters of Mercy began in America.
“For us as Mercy leaders, coming to Pittsburgh and connecting with this legacy reinforces the importance of what we do for patients in our communities,” Mackin said. “The Sisters crossed an ocean to a new nation and forged their way so they could serve more people. It’s imperative we honor that level of commitment by ensuring we’re doing everything we can to better the care for the communities we serve.”
