Healthcare Competition and Consolidation Medicare Advantage and Consolidation’s New Frontier — The Danger of UnitedHealthcare for All (New England Journal of Medicine) Hayden Rooke-Ley, Soleil Shah, and Erin C. Fuse Brown This article describes the recent ransomware attack on Change Healthcare and the ownership structure of UnitedHealth Group, including how much market power it has with medical claims, data analytics, insurance, physicians, PBMs, pharmacies and a bank.  The authors note the risks involved in these types of conglomerations, including market abuses that raise costs, erode quality of care, and harm …

In late June Novant announced it would abandon attempts to buy two Community Health Systems (CHS) hospitals in North Carolina.  This announcement followed a preliminary ruling in Federal District Court for Novant and a subsequent appellate court ruling for the Federal Trade Commission (FTC). Regardless of the final outcome of the merger, the preliminary Novant win is significant because it represents a successful use of the often cited, rarely successful, “failing firm” defense – which parties can potentially use to push through a merger that would otherwise create an unacceptable …

Mergers, Acquisitions and Healthcare Competition Is There Too Little Antitrust Enforcement in the U.S. Hospital Sector? (American Economic Association) Zarek Brot-Goldberg, Zack Cooper, Stuart Craig, Lev Klarnet From 2002 to 2020, there were more than 1,100 hospital mergers with a 1% enforcement rate by the FTC resulting in only 13 blocked transactions. The authors of this study speculate low rates of enforcement could be due to factors including budgetary issues and jurisprudence that favors mergers. It is estimated these mergers resulted in a high concentration of hospital markets in “90% …

On May 16, 2024, a Federal District Court Judge dismissed a case filed in 2022 by the Oregon Association of Hospitals and Health Systems (OAHHS, the trade group representing hospitals in Oregon) against the State of Oregon and the Oregon Health Authority (OHA).  The suit challenged the law created by Oregon HB 2362, 2021 legislation that required health care entities that meet minimum thresholds to obtain state approval before any mergers or acquisitions.  The new law created the Health Care Market Oversight (HCMO) program, housed within the Oregon Health Authority …

Effects of Market Consolidation Cost, Quality, and Utilization After Hospital-Physician and Hospital-Post Acute Care Vertical Integration: A Systematic Review (Medical Care Research and Review) Alexandra Harris, Sarah Philbin, Brady Post, Neil Jordan, Molly Beestrum, Richard Epstein, Megan McHugh To determine the impact of vertical integration, the authors examine the associations between two types of integration, hospital-physician and hospital-Post Acute Care (PAC), and their effect on cost, quality, and utilization of healthcare services as they relate to affordable care. Assessment of these impacts through the lens of financial benefits the found …

Healthcare Cost and Spending Promoting Value-Based Healthcare Decisions: A Case Study of Shared Savings Programs in New Hampshire and Maine (Pepperdine Policy Review) Christopher LaCreta and Lawson Mansell Shared savings programs (SSPs) are an emerging policy solution to combatting the rise of healthcare costs. SSPs enable patients to compare prices and receive incentives for saving money on some elective services. Researchers from Pepperdine University’s School of Public Policy recently published results from their case study on the disparities between SSPs in Maine and New Hampshire. Both states passed legislation to …

This spring, court cases are dealing with a variety of issues relevant to healthcare marketplace competition issues.  These include a Federal Trade Commission’s (FTC’s) action to block a sale of hospitals in North Carolina, examining the fiduciary duties employer-sponsored health plans have in selecting drug plans, and looking at the acceptability of non-compete clauses in physician contracts. FTC Files suit in North Carolina In February, the FTC authorization of a suit to block Novant Health’s proposed acquisition of two hospitals owned by Community Health Systems (CHS) in North Carolina.  On …

Healthcare System Mergers and Investments Private Equity-Acquired Physician Practices and Market Penetration Increased Substantially, 2012-21 (Health Affairs) Ola Abdelhadi, Brent D. Fulton, Laura Alexander, and Richard M. Scheffler The awareness for private equity’s influence on the healthcare sector continues to grow and be quantified. Generally, there has been concern among parties in the health care system regarding the rate at which private equity firms have been acquiring physician practices, creating antitrust, quality, and pricing concerns within the broader health system. A new Health Affairs study estimated the local market share …

The California Legislature wrapped up its annual introduction period for new bills on February 16. Among the wide swath of proposed health care bills, one, in particular, has caught the attention of many legal experts and players in the health care field. AB-3129 was introduced by Assemblymember Jim Wood and Attorney General (AG) Rob Bonta on the last day of the introduction period.  It proposes sweeping regulations around how private equity firms and hedge funds can participate in owning and managing healthcare facilities. The introduction of the bill comes amidst …

The preponderance of research evidence demonstrates that a lack of meaningful healthcare market competition is bad for consumers – resulting in higher prices, and insurance premiums, without a commensurate increase in quality of care.  New merger guidelines issued in 2023 by the Federal Trade Commission and Department of Justice are just one indication that the Federal government is more closely examining proposed health system mergers.  Increased regulatory scrutiny, among other factors, appears to be causing a slow-down in healthcare merger activity. In addition to merger challenges by state and federal …