Industry Consolidation

How Healthcare Leaders Can Weigh Pros, Cons of Payer Megamergers

December 12, 2023 - When rumors circulate about major payers planning to merge, it always stokes the question: are payer megamergers ultimately good for the healthcare system? When the news broke that Cigna and Humana may be in talks about a merger, Richard Ricciardi, professor in the School of Nursing and the executive director for the Center for Health Policy and...

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4 Key Inflators That Are Fueling Medical Cost Trends, Pricing

by Kelsey Waddill

What drivers influence the medical cost trend, and what steps can payers take to address these factors? The medical cost trend is the percentage that experts anticipate treatment costs will grow...

AHIP Urges 4 Types of Policies to Reduce Healthcare Spending

by Kelsey Waddill

AHIP offered four recommendations to the Senate Finance Committee on Consolidation and Competition (the Committee) to support healthy competition and lower healthcare spending in the healthcare...

Vertical Integration Raises Spending for Medicare Advantage Plans

by Victoria Bailey

Owning related businesses was associated with higher healthcare expenditures for Medicare Advantage plans, pointing to some of the consequences of vertical integration, a report from the USC-Brookings...

Elevance Health Will Acquire BCBSLA, Improve Care Access in LA

by Victoria Bailey

Elevance Health has announced plans to acquire Blue Cross and Blue Shield of Louisiana (BCBSLA), with the payers aiming to improve care access, quality, and affordability for Louisiana...

AMA: 79% of Medicare Advantage Markets Have Little Competition

by Victoria Bailey

Nearly 80 percent of metropolitan statistical areas (MSAs) had highly concentrated Medicare Advantage markets, highlighting the lack of competition in the commercial health insurance market. The...

AHA: CBO Report Inaccurately Assessed Commercial Insurance Premium Drivers

by Kelsey Waddill

The American Hospital Association (AHA) found that the Congressional Budget Office (CBO) did not accurately portray health insurance premium drivers, specifically that the office neglected to...

Health Insurance Industry Consolidation Grew from 2014 to 2020

by Kelsey Waddill

Health insurance industry consolidation continued to increase, restricting consumers’ options for coverage, an American Medical Association report argued. “As merger...

Congress Repeals Anti-Trust Exemptions Over AHIP Objections

by Kelsey Waddill

Both houses of Congress have voted to repeal an anti-trust exemption in the McCarran-Ferguson Act of 1945 which protects payers from federal competition laws. The Competitive Health Insurance Reform...

ProMedica Accused of Anti-Trust Actions, 50% Market Domination

by Kelsey Waddill

McLaren St. Luke’s has filed an anti-trust lawsuit against ProMedica Health System to prevent it from retracting Paramount commercial and Medicare Advantage health plan coverage. According to...

BCBSA Settles Anti-Trust Litigation for $2.7B, Anthem Pays 22%

by Kelsey Waddill

Blue Cross Blue Shield Association (BCBSA) has nearly concluded an eight-year-long anti-trust litigation with a $2.67 billion settlement, according to court documents which the Office of the Insurance...

AMA: 56% Increase in Payer Market Consolidation In Past 5 Years

by Kelsey Waddill

Payer market consolidation has been increasing over the past five years and this consolidation is having negative effects on consumers, the American Medical Association (AMA) asserted in its latest...

House Amendment Imperils Payer Anti-Trust Exemption

by Kelsey Waddill

The House of Representatives has passed HR 1418, the “Competitive Health Insurance Reform Act,” reintroducing questions about whether healthcare payers should be allowed to fall under an...

Blues Plans Highmark, HealthNow New York Announce New Affiliation

by Jacqueline LaPointe

Highmark Inc. is expanding its business into New York under a proposed affiliation agreement with HealthNow New York Inc. “Under the terms of the affiliation agreement, Highmark’s parent...

Role of Market Share In Payer-Provider Reimbursement Negotiations

by Kelsey Waddill

Private payers pay nearly double the amount that Medicare pays for certain services and a hospital’s market share play a significant role in the positive margin, a recent literature review...

Centene, WellCare Finalize Major Health Payer Merger Deal

by Samantha McGrail

Centene and WellCare announced they have finalized a major health payer merger deal that will combine the two organizations into the largest health insurer by membership with more than 24 million...

Humana Plans to Acquire a PBM in Vertical Industry Consolidation

by Kelsey Waddill

Humana announced that it is pursuing a vertical consolidation deal with Enclara Healthcare, one of the largest hospice pharmacy and benefit management providers (PBMs) in the country. Humana will...

VC-Funded Payer Bright Health Secures $635M in Series D Round

by Kelsey Waddill

Bright Health Plan today announced that it has secured $635 million in Series D funding from the NEA, as VC-funded payers look to 2020. The funding was an oversubscription, exceeding the amount of...

Centene-WellCare Merger Prompts Sale of IL Medicaid and MA Plans

by Kelsey Waddill

Centene announced that it will be selling IlliniCare Health Plan, Inc. and Centene’s Illinois Medicaid and Medicare Advantage plans to CVS Health in order to prepare for Centene’s merger...

Payer Industry Consolidation Threatens Independent Providers, Premiums

by Kelsey Waddill

Seventy-five percent of the payer industry is made up of highly concentrated markets, a number that has been rising since 2014, an American Medical Association (AMA) study found. And in turn, public...

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