From Fragmented Processes to Strategic Unity: How Mercy Transformed Payer Strategy with CorroHealth

Hospitals across the country are grappling with increasingly aggressive payer behavior, especially from Medicare Advantage (MA) plans. For many, the response has been reactive—focused on appealing denials or defending medical necessity after the fact. But at Mercy, a multi-state health system with a high MA mix, leadership knew that survival required something more fundamental: aligning internal teams around a unified strategy, powered by actionable data.

Their solution wasn’t just a denial management program. It was a long-term, systemwide shift in how clinical, operational, and financial teams worked together—made possible through a five-year partnership with CorroHealth.

The Challenge: Rising Pressure, Fragmented Response

Mercy, like many large health systems, saw an increase in MA-related payment issues. Denials were on the rise, but so were costs tied to the administrative effort required to challenge them. Peer-to-peer reviews often delivered inconsistent results, and the hospital teams responsible for utilization review, finance, and managed care operated in silos—each managing their own “piece” of the post-bill puzzle.

What Mercy needed wasn’t more staff or more manual appeals. They needed clarity: visibility into what was happening by payer, by facility, and even by midnight. They needed a way to identify which payers were driving the most friction, where internal processes were breaking down, and how to focus efforts where they would have the most impact.

The Turning Point: A Partnership Anchored in Strategy

Mercy had long recognized the need for a more effective, coordinated approach, but it wasn’t until their partnership with CorroHealth that the pieces came together. Over the course of five years, the two organizations worked collaboratively to move beyond reactive denial response—building a program that empowered Mercy to proactively manage payer behavior, align internal strategies, and focus resources where they could drive the greatest impact. The foundation of that work was governance. Weekly meetings brought together leaders from utilization management, managed care, CDI, physician advisory, and finance. These weren’t just report-outs. They were strategic working sessions grounded in data—data provided by CorroHealth that showed exactly what was happening across the organization.

That visibility was transformative. By breaking down payer behavior by facility, by admission time, and by denial type, Mercy could finally manage its “controllables.” Instead of reacting to denials one by one, they began identifying patterns, shifting status decisions proactively, and engaging in payer conversations with evidence, not anecdotes.

Data That Drives Alignment

One of the most powerful tools in Mercy’s strategy was the ability to reframe long-standing metrics in a new light. Take CMI, for example. Instead of viewing it as a static measure of documentation quality, Mercy used CMI alongside DRG validation and payer data to reveal care pathways that needed realignment. This helped eliminate finger-pointing between departments and instead fostered shared ownership of outcomes.

The same applied to peer-to-peer reviews. Rather than treat them as transactional events, Mercy analyzed the return on investment of each P2P effort—what worked, with which payers, and under what conditions. That allowed them to target future engagement more precisely and educate physicians on how and when to escalate appropriately.

CorroHealth’s analytics and strategic insight were instrumental in this process. Their teams helped Mercy make sense of complex data sets, guided interpretation, and worked alongside internal stakeholders to develop tailored strategies for each payer and facility.

Results That Reflect Strategic Maturity

While financial improvement wasn’t the sole focus of Mercy’s approach, the results spoke for themselves. By Q1 2024, the system saw a measurable increase in inpatient realization, stronger performance in key revenue indicators, and a marked reduction in internal friction. But more importantly, they had built a program that was resilient, repeatable, and aligned across clinical and financial domains.

This wasn’t about winning more appeals or getting more denials overturned. It was about designing a system that minimized unnecessary payer friction in the first place—something only possible through long-term partnership, strategic governance, and trusted data.

A Model for Other Health Systems

Mercy’s story isn’t one of a quick fix. It’s a case study in strategic persistence: how a large, complex organization took control of what it could, aligned its internal teams, and created a payer strategy built for long-term success.

For other health systems navigating the same payer pressures, Mercy’s example offers a blueprint:

• Start with data.
• Build a cross-functional governance model.
• Align on outcomes—not just metrics.
• And above all, commit to the long game.

CorroHealth’s role in this success was not simply to provide services, but to act as an extension of Mercy’s internal teams—a partner in navigating complexity, enabling insight, and reinforcing strategy with action.