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Carolinas HealthCare System

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Carolinas HealthCare System battles on against Feds


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.

Feds accuse Carolinas HealthCare of restraint of trade


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.


Insurers skeptical about precision medicine’s benefits



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.”


More systems eye entering insurance business



In western North Carolina’s mountains.
One large health system in North Carolina is ready to launch a Medicare Advantage plan, and two others  in the Tar Heel state are mulling the pros and cons of becoming a payer. Cone Health, a $1.4 billion health system in Greensboro,  has received a state license to sell health insurance, and it’s in the process of receiving approval from the the Centers for Medicare and Medicaid Services to offer Medicare Advantage plans to seniors.

Modern Healthcare reports that “Health systems are increasingly jumping into the insurance space. Even though costly information technology and complicated actuarial predictions are large hurdles, organizations view health plans as the missing piece to the population health puzzle. If people in a hospital system’s service area are willing to go to those providers for care, why not offer the coverage to pay for it and keep the healthcare dollar local?””Cone Health runs a Medicare Accountable Care Organization called Triad Healthcare Network, which earned more than $10.5 million in shared savings in its first year. The early success of that ACO gave executives confidence that they could move to the more aggressive, capitated Medicare Advantage structure, in which the federal government pays private insurers lump sums for each member.”

Meanwhile, Mission Health, a $1.4 billion hospital network based in Asheville, is looking into entering the insurance business, though so far anyway,  the  system would prefer to build partnerships with established insurors rather than get into the business directly.

And Charlotte-based Carolinas HealthCare System, the largest system in the state, with almost $5 billion in annual revenue (PDF), also has no immediate plans to build a commercial insurance business.

But, Modern Healthcare reports, “Carolinas is changing how it works with insurers. The system was the first in the state to create a narrow-network product with Blue Cross and Blue Shield of North Carolina, the state’s dominant insurer. Carolinas is also participating in bundled payment programs with local employers, where Carolinas receives a fixed amount of money for certain cardiovascular procedures.”

The eyes have it: The growing role of optometrists


In another sign of the increasing role of non-physician clinicians, Modern Healthcare reports, “o}ptometrists are working more closely with physicians and insurers to identify patients’ chronic conditions and make sure those patients receive appropriate medical care. They want to demonstrate that they have the training and skills to do more than just fit people for glasses and contact lenses.”
An example: “The Charlotte, N.C.-based Carolinas HealthCare System is working with Vision Source, a Kingwood, Texas-based network of 3,800 independent optometrists, to boost its performance in serving diabetes patients and raise its diabetes-care quality score.”
“Three white papers done at UnitedHealthcare found that eye-care professionals were effective in identifying patients with diabetes, high cholesterol, hypertension, juvenile rheumatoid arthritis and multiple sclerosis. ”

Using community input to build medical home


Video: Carolinas HealthCare System officials discuss how they use community input to build a medical home and improve population health.

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(617) 230-4965

Wellesley, Mass