Antitrust enforcement in health care It got tougher under President Joe Biden, with mixed results.
The Federal Trade Commission has prevented health care systems from becoming too large, while the Justice Department unsuccessfully challenged the UnitedHealth Group’s purchase of health financing and billing data company Change Healthcare.
Hal Andrews, CEO of healthcare analytics firm Trilliant Health, thinks regulators are getting it all wrong. In conversation with Roth, Andrews suggested better ways to control costs than preventing mergers and acquisitions.
This interview has been edited for length and clarity.
How should antitrust regulators approach health care?
I think the consent decree approach where you’re trying to acknowledge that there is an underlying capital and operational inefficiency that could be remedied by closing a facility and trading for greater access in the slums.
So do not oppose mergers and acquisitions?
Instead of blocking deals, I’m going to try to get consent decrees where it says, “You can close this, but I want you to build a 20,000-square-foot mobile medical facility with primary care imaging and emergency department stands. And in that market, you’ve got to build three of them. And we’ll tell you where you have to.” to build it.”
I think this is a much better place than just saying, “No, you can’t do that.”
Do you agree with the Federal Court’s decision to allow UnitedHealth to acquire Change Healthcare?
United will make $1 billion a day in revenue. Billion. According to them, they employ or are affiliated with 65,000 physicians, which is 10 percent of the physicians practicing in the United States. So if that’s not a problem, I don’t know how anything else could be.
The Department of Justice is looking into purchasing CVS for home care company Signify Health. what do you think?
I think this is a more ridiculous chase. I know of nothing more popular than the home health industry, with the exception of gas stations and liquor stores. I mean, they’re literally tens of thousands of home health workers. And I don’t know how Signify moves the needle on that. I just don’t understand how you can make the argument that you can influence the market or create anti-competitive situations.
By comparison, it can [UnitedHealth’s pharmacy benefit manager] Optum profiting from the data set Changing health care in ways that harm others? Definitely.
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Pulse check
In 2020, private health insurance companies paid Roughly the same amounts for virtual visits as they did for in-person visits, according to New analysis From the Kaiser Family Foundation.
The report says the finding could dampen enthusiasm among providers and insurers promoting telehealth as a cost-saving measure. But with telehealth, it may be easier for patients to see their doctors.
In the early stages of the pandemic, the analysis said, the federal government expanded reimbursement for telehealth to help steer people out of the path of the virus, and private insurers followed suit, boosting rates.
After analyzing more than 76 million claims, the researchers concluded, most physicians were charging the same for telehealth and in-person visits.
Payments were also similar for mental health treatment, virtual or not.
“We don’t know at this point whether private insurers continue to pay for telehealth on an equal basis with in-person care,” the researchers said. “However, if telehealth payments continue to be in the same vein as those for in-person care, this raises questions about whether telehealth will reduce public health spending, as some have predicted.”
But the search for pay parity wouldn’t surprise most employers. About two-thirds of corporate leaders already consider telehealth to be financial laundering, with just 4 percent expecting more use of telehealth will raise costs, while 6 percent say they think it will reduce them.
“The primary benefit of expanding telehealth may be increased access to services and convenience for registrants,” the researchers wrote, adding that most employers believe telemedicine will play a major role in enhancing access.
Amazon is taking off Prescription subscription. The new service called RxPass allows Prime members for $5 a month to get prescription-eligible medications. There are more than 50 medications listed that treat about 80 conditions.
The new service competes with discount drug companies like Mark Cuban Cost Plus Drug Company and GoodRx, as well as online prescription delivery services from big drugstore brands like CVS.
Online pharmacies have been around for years, but so far they have failed to gain traction. Most people still go to their local chemist to get their medication. However, the pandemic has accelerated the use and delivery of online prescription orders.
Since 2018, Amazon has initiated several healthcare initiatives including its telehealth service, which has since closed. In the past few years, the company has acquired drug delivery and packaging service PillPack, Health Navigator, and primary care chain One Medical.
