July 28, 2020

Mercy Care Health Equity and Community Intervention

At Mercy Care we are committed to helping our members live a healthier life and achieve their fullest potential. Our work has focused on addressing social determinants of health with a comprehensive approach to improve outcomes in the areas of housing, school-based services, women’s health and addictions.

With this work as our foundation, we also recognize that health disparities remain widespread among people of color. We are building a strategy that will allow us to confront these disparities through health equity and community intervention.

Through this work we will develop, implement and lead our initiatives to build equity within Mercy Care and the communities we serve by abolishing systemic racism, including inherent and unconscious bias, that contributes to health disparities. These include social determinants of health that impact the health and well-being of our colleagues, members, providers and communities.

The announcement of our commitment is not the conclusion of a process but an ongoing, dedicated effort that will be embedded in our culture. Together with our community, we will help our members live a healthier life and achieve their full potential.

October 7, 2019

Positive expectations for Arizona's Direct Care Workforce efforts

Twenty-four states have implemented Medicaid managed long-term services and supports (MLTSS) programs to promote quality and care coordination as well as curb rising Medicaid spending. However, for these states to be successful, they will need a stable, competent workforce to fulfill an estimated 4.2 million direct (attendant) care jobs over the next 6 years. Currently, these states face immense challenges in workforce recruitment and retention of attendant care workers.

Current situation

The attendant care workforce has more than doubled in the past decade. Yet, despite progress, economic stability among workers remains poor:

  • Turnover at private-pay agencies remains over 80 percent1
  • 2 out 5 work part time
  • Median annual income is $16,200
  • 1 in 5 lives in poverty
  • Over half rely on some form of public assistance

Future situation

Over the next six years the attendant care workforce will rank among the top five occupations in the U.S. and will grow more than any other single occupation.

However, according to the Institute for the Future of Aging Services:

“…the quality of long-term care—the recipients’ clinical and functional outcomes and quality of life—is significantly influenced by the attributes these workers bring to their caregiving jobs, the education and training they receive, and the quality of their jobs. The attitudes, values, skills and knowledge of these workers, how they are compensated and rewarded, and the way their jobs are organized and managed, all have a role to play in determining long-term care quality. Workforce development activities designed to increase the capacity of these individuals to participate effectively in long-term care settings should be integrated into all ongoing and new long-term care quality improvement and quality assurance initiatives.”

Local efforts in Arizona

Mercy Care, Aetna’s Medicaid health plan serving the State of Arizona, is currently exploring how they can offer opportunities to collaborate with attendant care leaders to strengthen the attendant care workforce and improve outcomes. These opportunities include collaborative training programs, new data-collection systems, and value-based payment initiatives, among others.

According to Sarah Hauck, Workforce Development Administrator for Mercy Care, “Mercy Care is implementing seven Workforce Training and Development pilot initiatives that will support the creation of 6,000 - 10,000 new attendant worker positions in the field of long term care and enhance the recruitment, retention and training of contracted providers in their network.”

To prepare for the implementation of these pilots, Mercy Care selected Practical Training Solutions and the United Way of Tucson and Southern Arizona to identify people in the community who want to be direct care workers, train them to become certified, and then connect them with attendant care agencies in the community awarded contracts with Mercy Care.

Mercy Care also put out a Request for Information to attendant care agencies to serve as contracted providers that will hire the pipeline of direct care workers identified by the two organizations above. Out of the 15 provider agencies that submitted proposals, Mercy Care selected five for contract awards starting in January 2020. The selected agencies showed highly innovative and creative approaches to recruitment, retention and training, with a high focus of allocating funds directly to employee initiatives.

The Road ahead

Mercy Care will collect, monitor and analyze the outcomes of these initiatives with the hope that the pilots will help drive future statewide projects.




January 10, 2018

Partnership and Promise: Improving the health of a community

Integrated health care works. Supporting people with serious mental illness designations to address the social determinants of health—stable housing, employment, food security— has a positive impact on their path to recovery. See how Mercy Care does this every day with the results from research conducted by NORC at the University of Chicago.

Three research studies of programs and services offered by Mercy Care (formerly Mercy Maricopa Integrated Care), a Medicaid managed care plan, to address social determinants of health found some components of the programs can reduce cost and improve quality of care for people with serious mental illness in Maricopa County, Arizona.

Mercy Care is a not-for-profit 501(c)(3) organization. Mercy Care is sponsored by Dignity Health, Ascension Care Management.

The studies were conducted by the independent research institution, NORC at the University of Chicago

The NORC studies looked at the experience of members enrolled in supportive housing, supported employment, and Assertive Community Treatment services, as well as the applicable program’s effect on the cost and quality of care and the utilization of services by adults with serious mental illness. The services in Maricopa County are combined at single community provider locations to make sure members have access to supportive services, as well as physical and behavioral health care.

The research findings suggest shifting services from more intensive inpatient and residential stays to outpatient and routine behavioral health care focused on chronic illness can affect cost and quality of care.

“Working collaboratively with providers, local stakeholders, the City of Phoenix, Valley of the Sun United Way, and the state of Arizona, we have shown that fully integrated care addressing social factors is the right way to meet the needs of Medicaid members with complex conditions,” said Mark Fisher, CEO of Mercy Care.

Addressing social determinants of health leads to positive health outcomes

The research found that members enrolled in the Supportive Housing intervention experienced decreases in total cost of care of 24 percent after enrolling in the program, while members in the Assertive Community Treatment intervention experienced significant reductions in certain costs, including a 6 percent relative decrease in per member per quarter costs in behavioral health professional services, an 11 percent relative decrease in health facility costs, and an 8 percent reduction in emergency department visits. [1] Members enrolled in the Scattered Site housing program had an average health care cost of about $20,000 per member per quarter in at least one quarter before starting in the supportive housing program. [2] After enrolling in the supportive housing program, members experienced a $4,623 reduction per member per quarter in total cost of care. These members also had fewer psychiatric hospitalizations than they had before enrolling in the program. While Supported Employment led to an increase in overall costs for enrolled members, likely because of the cost of the supported employment services and increases in other services, members who received supported employment services experienced varying degrees in reduction in both inpatient medical and psychiatric hospital stays, including a 35 percent decrease in inpatient medical hospitalizations.[2]

View an infographic that displays the study's compelling results.

Continuing support for better community health

Mercy Care and its partners showed a commitment to prioritizing member needs and a dedication to working with community stakeholders to ensure those needs were identified and addressed. Qualitative findings from this research suggests, that the increase in social support led to increased focus by members to obtain and regularly use sources of care – decreasing the need for emergency or inpatient services. Integrated care streamlines the process of accessing care for members with serious mental illness. Having services within the clinics, for example, allows clinical teams to send a direct referral to a supported employment provider – enabling members to access these services immediately and reducing the interruption that occurs when members need to seek care somewhere else. Continued education among clinicians and staff is also important to ensure they’re familiar with changes, additions, or new programs to help them provide better care to members. Mercy Care created educational toolkits, known as Placemats or decision trees, to inform its staff of the discharge referral process. This way, members are provided with support and resources to help them remain healthy. [1] These reductions were per member per quarter and represent the approximate difference in total cost before and after the receipt of supportive housing services and are not necessarily directly attributable to the programs themselves. Each evaluation also included an analysis comparing those in the program to a matched group not in the program. For housing, this analysis found that there was a reduction in total cost of care of $5,002 per member per quarter relative to a comparison group.

[2] These reductions were per 1,000 members per quarter and represent the difference in total cost of cost before and after the receipt of services and may not be directly attributed to the programs themselves. Each evaluation also included an analysis comparing those in the program to a matched group not in the program. Members in the Assertive Community Treatment program, averaged 187 fewer outpatient emergency department visits per 1,000 members per quarter relative to those who did not receive the services, which was a significant decrease in utilization.