Carolinas HealthCare System, North Carolina’s largest hospital chain, has urged a federal judge to reject the U.S. Justice Department’s suit that alleges that the system imposed anti-competitive contract requirements on insurers. The system asserted that a federal appeals court has rejected the government’s arguments involving similar contract arrangements in a case involving American Express.
Modern Healthcare reported what led to the Carolinas case:
“The 10-hospital system has steering provisions in contracts with Aetna Health of the Carolinas, Blue Cross and Blue Shield of North Carolina, Cigna Healthcare of North Carolina and United Healthcare of North Carolina. Those insurers make up 85% of the commercially insured market in the Charlotte area, the Justice Department said.
“In exchange for the steering provisions, Carolinas provided the insurers with discounted rates for its facilities and services. Without the arrangements, the health system claims the insurers would take advantage of its inclusion in their networks.”
To read the Modern Healthcare article, please hit this link.
Photo by Grey Wulf
The Charlotte Observer reports that a federal lawsuit alleges that Carolinas HealthCare System, North Carolina’s largest hospital chain, illegally reduced competition in the Charlotte area, limiting patient choice and driving up costs.
The lawsuit alleged that Carolinas used “unlawful contract restrictions” to stop Greater Charlotte area insurers from suggesting that member patients use one of Carolinas’ competitors with lower prices.
HealthcareDive reported that the “contracts also encouraged insurers to promote use of CHS hospitals, and at least in one case stipulated an insurer in no way steer business away from CHS.”
The lawsuit accuses CHS of using the steering contracts with Blue Cross Blue Shield of North Carolina, Aetna Health of the Carolinas, Cigna Healthcare of North Carolina and United Healthcare of North Carolina, together having 85 percent of the commercial market in the Charlotte area.
A spokesman for CHS told the Observer the system’s contract provisions are not unique. “The system is being sued for something that takes place on a regular basis across the country,” he said.
In any event, the lawsuits reflects the Feds’ toughening attitude toward powerful hospital systems.
An example of the results of automated chain-termination DNA sequencing.
Stat reported that insurers are pushing back on requests to pay for “precision medicine,” which is based on heavy use of genetic tests.
Among other things, the payers worry that the tests could lead to care that won’t improve patient outcomes but will dramatically drive up healthcare costs. Patients and their families are likely to demand them more and more.
But FierceHealthcare reported that Gregory R. Weidner, M.D., medical director of primary care innovation and proactive health at Carolinas HealthCare System, asserted that precision medicine goes far beyond genetics, saying that the goal is to “individualize and personalize care based on a variety of factors, which would include their genomic profile as well as various elements of their environment, lifestyle, personal preferences.”
Fierce reported “some organizations have been arranging meetings between insurers and companies working on sequencing cancers to find some common ground.”