Should Big Insurance Become Like Walmart To Lower Health Costs?

Should Big Insurance Become Like Walmart To Lower Health Costs?

Salinas, United States - April 8, 2014: Walmart store exterior. Walmart is an American multinational corporation that runs large discount stores and is the world's largest public corporation.

http://www.npr.org/sections/health-shots/2016/08/11/488891554/should-big-insurance-become-like-walmart-to-lower-health-costs

Retail titan Walmart uses its market dominance to inflict “ruthless,” “brutal” and “relentless” pressure on prices charged by suppliers, business writers frequently report.

What if huge health insurance companies could push down prices charged by hospitals and doctors in the same way?

The idea is getting new attention as already painful health costs accelerate and major medical insurers seek to merge into three enormous firms.

Now that hospitals have themselves combined, in many cases, into companies that dominate their communities, insurance executives argue the only way to fight bigness is bigness.

Judge: Only time for one insurer merger case in 2016

http://www.fiercehealthcare.com/payer/judge-only-time-for-one-insurer-merger-case-2016?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWldRd1kyUXpNalUwWXpFeCIsInQiOiJaWkJVWkdKWG9DSFJwYytCZmVHV1JKcFhVd1lZbUlHS1JjZTZHZWI2ZDl3dU1XNU5oTWpCY3lSU3BYaWtyZXVyeGZmbDdyTVFHWk5OQUhEQzhlZkdlNm9lTnE3Y2M2elhcLzRrN3F5aXFKXC9RPSJ9

A federal judge said Thursday it is unlikely he would be able to rule on both the Aetna-Humana and Anthem-Cigna antitrust suits by the end of the year, according to Reuters.

Lawyers from Anthem and Aetna argued this week that Judge John Bates should hear their cases before the end of 2016. The Justice Department filed suits in July against both mergers, citing competition concerns that it says would increase prices for consumers and stunt innovation.

Bates said in a hearing Thursday that both requests cannot be fulfilled, but did not say which case would be sent for reassignment.

“That’s my determination: that I can’t do both,” Bates said in the hearing, according to Reuters.

Aetna believes it has a simpler case, the article adds. Further, its deal with Humana was announced first.

Anthem’s lawyers, though, point out that if the case is not settled by the end of the year, Cigna will likely refuse to extend their agreement, thus dooming the merger, Reuters notes.

In an interview with FierceHealthPayer, antitrust lawyer David Balto indicated that the Anthem-Cigna merger is “like climbing Mount Everest,” and that they are less poised to battle the DOJ than Aetna and Humana.

What can we expect in healthcare with Clinton, Trump?

http://thehill.com/blogs/congress-blog/healthcare/289527-what-can-we-expect-in-healthcare-now-that-clinton-and-trump

Now that our presidential nominees are set and the general election has begun, what do our nation’s hospitals and health systems need to do, whether Secretary Clinton or Mr. Trump is elected in November? They, and their parties, offer stark contrasts, but what will they mean for hospitals?

CMS needs to halt the march to health care gigantism

CMS needs to halt the march to health care gigantism

From a major speech by Sen. Elizabeth Warren to a recent report from the President’s Council of Economic Advisers, there has been a renewed interest by Democrats in monopolies and market consolidation. From tech to airlines, they argue, too many sectors of the economy are being dominated by a few big players.

In American health care, this is not only the case, but has been the default preferred stance. In health care, there is an almost Darwinian belief that the evolution to bigger is better. This is why last year saw 112 hospital mergers (up 18 percent from 2014), and the percentage of physician practices owned by hospitals doubled between 2004 and 2011.
Yet, there is no evidence that consolidation of hospitals and physician practices leads to better clinical outcomes or cost reductions. In fact, recent studies suggest that small, physician-owned practices have a lower average cost per patient, fewer preventable hospital admissions, and lower readmission rates than hospital-owned practices.
That is why it is so unfortunate that, as part of the largest rewriting of doctor payment rules in a generation, the Centers for Medicare and Medicaid Services (CMS) unwittingly has drafted regulations that—as currently proposed—further neglect the power of physician independence and create strong incentives for further consolidation in health care.

Anthem’s Good, Bad and Ugly News

http://www.bloomberg.com/gadfly/articles/2016-07-27/anthem-earnings-the-good-the-bad-and-the-ugly?_hsenc=p2ANqtz-9r6DeQcVMyNnafhqaWRYPxsGcyFkKJ80w17xLndiqVNIIOrCFlnm-c4sSm8WS6EqhbFxAmVmQuwhj1GdEe1f5nt4irUw&_hsmi=32205122&utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_content=32205122&utm_medium=email&utm_source=hs_email

Anthem had some good headlines on Wednesday. The insurer reported second-quarter earnings and revenue that topped estimates, with the latter jumping 7.2 percent from a year earlier. It expects to insure more people than it initially forecast this year, after surprisingly robust growth in its Medicaid business.

But beneath the good, there was also bad and ugly.

Standard & Poor’s puts Aetna, Humana on credit watch following DOJ move to block merger

http://www.healthcarefinancenews.com/news/standard-poors-puts-aetna-humana-credit-watch-following-doj-move-block-merger

S&P Global Ratings has placed Aetna and Humana on creditwatch following the Department of Justice’s announcement Thursday to block their merger.

S&P said it has placed its ratings on Aetna on creditwatch with developing implications, and on Humana and its core subsidiaries on creditwatch with negative implications.

The DOJ also blocked the merger between Anthem and Cigna on Thursday.  S&Psaid its ratings on the two insurers would remain on creditwatch negative, where they were placed on June 21, 2015.

Anthem and Aetna have both said they would fight the DOJ’s injunction against their respective mergers in court.

For Anthem’s proposed $53 billion acquisition of Cigna, litigation could be difficult and time-consuming, S&P said.

Failed merger won’t stop Mass. hospital from $200M expansion

http://www.beckershospitalreview.com/hospital-transactions-and-valuation/failed-merger-won-t-stop-mass-hospital-from-200m-expansion.html

DOJ sues to block Aetna-Humana, Anthem-Cigna mergers

http://www.fiercehealthcare.com/payer/doj-sues-to-block-aetna-humana-anthem-cigna-mergers?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWkRFMk5ERTBOemd5TkRZMyIsInQiOiJiaEZQV3RZeFFXVUR5TFwvTDhmd2JBc2ppRzVpRjY3eDN5b1Q1aXh3aHV5VDdud2xpblFBME92bkl2ZFQ2NXZOZ1BEZ3BqSkZ2Y2NGUDA2aG5laE5JMzhIeTJ4UWNuckxkUkI0bVwvdFRyM3o0PSJ9

Justice Department building inscriptionJustice Department building inscription

Value-Based Drug Pricing: Watch Out for Side Effects

http://www.commonwealthfund.org/publications/blog/2016/jul/value-based-drug-pricing?omnicid=EALERT1068913&mid=henrykotula@yahoo.com

What would penicillin cost under value-based pricing, a system in which drug makers set prices based on the benefits of their products to consumers and the larger society, rather than drugs’ costs of production? Penicillin has saved millions of lives since its first use in 1942, and it still works for many patients despite growing bacterial resistance to the drug. (Fortunately, many fewer patients get infections with pneumococcus now because we have a good vaccine for it.) Surely, under value-based pricing, penicillin would sell for thousands or tens of thousands of dollars a dose.

Anthem-Cigna Deal: Seeking Merger Approval, Anthem Makes Major Donations To State Political Groups

http://www.ibtimes.com/political-capital/anthem-cigna-deal-seeking-merger-approval-anthem-makes-major-donations-state

Money in Sky

Seeking regulatory approval for a controversial merger proposal, health insurer Anthem recently pumped $460,000 into groups supporting the election campaigns of governors and state attorneys general. The money was disclosed in second-quarter campaign finance reports reviewed by International Business Times.

Those federal filings, which were released by the Internal Revenue Service late Friday, show Anthem gave $210,000 to the Republican Governors Association, $200,000 to the Democratic Governors Association in the last three months. In many states, the insurance commissioners reviewing the proposed Anthem-Cigna mega-merger are appointed by governors. The cash to state officials is on top of $50,000 Anthem gave to a Democratic-affiliated political group called “Unity Convention 2016.”

The money to the DGA is particularly notable because the group is headed by Connecticut Gov. Dannel Malloy, whose insurance commissioner, Katharine Wade, runs the agency leading the national multistate review of the deal. Anthem money flowed to the DGA in June amid an ethics probe prompted by IBT’s investigative series documenting Wade’s personal and familial ties to Cigna.

Malloy has refused to force Wade to recuse herself from the merger review, at a time when Anthem and Cigna have increased their donations to the DGA, which backed his campaigns and which he has chaired since late 2015. In all, the DGA has raised a total of $1.1 million from Anthem and Cigna since Malloy began the process of nominating Wade to the insurance post in 2015. That sum is 37 percent more than the group raised in the entire 2014 election cycle, and almost half of the total campaign contributions the companies have given the group in the last decade.