Despite what Anthem Inc. Chief Executive Joseph R. Swedish called “dynamic tension” with Cigna Corp. over their proposed $48 billion merger, he said the health insurers are on track to receive regulatory approval and proceed with the merger. Many healthcare providers oppose the merger, fearing the huge new entity will be able to cut tougher deals. See this link.
Herewith, from Becker’s Hospital Review, a list of six accountable-care and shared-savings agreements signed in November and December:
“1. Saint Francis HealthCare Partners, UnitedHealthcare team up for accountable care: 3 things to know
Hartford, Conn.-based Saint Francis HealthCare Partners, a joint venture between a network of primary care and specialty physicians and Saint Francis Hospital and Medical Center, and UnitedHealthcare are collaborating through a new accountable care relationship.
“2. Delaware Valley ACO expands partnership with Humana
Philadelphia-based Delaware Valley ACO and Humana expanded their accountable care relationship after seeing favorable results in the first year of their partnership.
“3. Humana, Collaborative Health Partners launch value-based care program
Lynchburg, Va.-based Collaborative Health Partners and Humana signed a value-based care agreement for 4,000 Humana Medicare Advantage members in the Lynchburg area.
“4. Lee Memorial, Florida Blue launch ACO
Ft. Myers/Cape Coral, Fla.-based Lee Memorial Health System’s affiliated physicians teamed up with Florida Blue to launch an ACO for businesses and individuals with commercial plans.
“5. Aetna, CHOP to collaborate on ACO
Aetna has announced a first among its ACOs — It is launching a pediatric accountable care program with The Children’s Hospital of Philadelphia.
“6. Cigna rolls out 2 new collaborative care arrangements in Chicago
Cigna is teaming up with two Chicago area physician groups, Alexian Brothers Clinically Integrated Network and Midwest Center for Women’s HealthCare, on collaborative care programs similar to ACOs.”
One of Goya’s “Titan” paintings.
The AMA denounced Aetna’s plan to buy Humana and Anthem’s plan to buy Cigna as anti-competitive. Many physicians worry that the new, even bigger insurance companies that would be formed by these mergers would have the ability to force down U.S. physicians’ compensation — the world’s highest compensation by far for doctors.
The insurers, for their part, assert that that the deals would let them offer cheaper insurance by using their increased size to negotiate better prices with physicians and hospitals.
The AMA said that the Anthem-Cigna behemoth would increase market power in 13 states where the behemoth would sell individual insurance plans and competition would decrease in all 14 states where Anthem currently operates Blue Cross Blue Shield plans.
The Aetna-Humana combination, the AMA said, would raise anti-competitive issues in 14 states overall.
The American Hospital Association recently said that its analysis of the deals found that they would cut competition.
The merger plans won’t necessarily go smoothly: The Justice Department is leery of huge concurrent transactions in the managed-care industry. And hospital officials and physician groups, fearing cuts in their revenues because of the new behemoth insurers’ bargaining power, oppose the acquisitions. Further, two congressional committees have scheduled hearings for the fall on the mergers.
As The Wall Street Journal noted, the “Aetna deal would create by far the biggest player in the private-insurer version of Medicare, so concern over market concentration will focus on the companies’ footprint in that business, known as Medicare Advantage. Mr. Bertolini said that the vast majority of Medicare Advantage consumers have at least five options currently, so ‘we don’t see a reduction in competition for consumers’ from the Humana deal.”
“He argues that the merged company will be better positioned to work closely with health-care providers and the federal government to bring down costs and improve quality.”
Humana’s booming Medicare business makes it an attractive acquisition target for Aetna, which focuses more on employer-sponsored health plans that have less unit growth potential than Medicare or Medicaid plans. And Humana has considerable experience in the fee-for-value world, Aetna less so.
“The health insurance industry deal speculation primarily focusing on Aetna’s ambitions comes just as the government plans to shift a huge amount of Medicare dollars away from the traditional fee-for-service approach to medicine that is based on volume and to medicine based on value that is tied to outcomes, performance and quality of care provided. Humana administers a large book of Medicare business Aetna may be interested in and larger amounts of capital may be needed to managed it from either insurer,” Forbes said.
