Amazon Is Already Reshaping Health Care
Its threat alone has helped speed consolidation, and consumers may suffer. nnWithout having done much yet, Amazon.com Inc. is already transforming U.S. health care — and not necessarily for the better.nnThe mere threat of the online giant getting into the health business prompted the country’s two largest pharmacy benefit managers — CVS Health Corp. and Express Scripts Holding Co. — to join forces with two of its largest insurers, Aetna Inc. and Cigna Corp. These deals will put more U.S. health care under the control of fewer companies. The merging companies say this will lower costs for consumers and the country. But the reality will likely be less rosy and more complicated.nnThat these companies can even make such deals is due partly to the Federal Trade Commission and the Department of Justice, which blocked the mergers of Anthem Inc. with Cigna and Aetna with Humana Inc. Those mega-insurers would have been too busy digesting to make big vertical deals and too large to be acquired by other insurers.nnUnitedHealth Group Inc. has been another major motivator for these mergers. It successfully pioneered a strategy of aggressive diversification by buying a large PBM in 2015 and with its Optum health-services unit. The gravitational pull of its success — it leads peers in patient enrollment, revenue growth, and market valuation — has inspired copycats. Profit pressure on PBMs, meanwhile, likely helped make them receptive to merging with insurers.nnBut Amazon’s long shadow also helped instigate these deals. With its technological prowess, long investment horizon, bottomless appetite for new business and tolerance for thin margins, any mention of its interest in health care rattles investors, particularly in the industry’s middlemen.nnIf the deals go through, the result will be an unprecedented level of market concentration.nnAll three of the biggest U.S. PBMs will be tied to three of the country’s biggest insurers. CVS, Express Scripts, and UnitedHealth process more than 70 percent of all U.S. prescriptions. Post-merger, three companies will insure more than 90 million people in some capacity, process more than 3.5 billion prescription claims, and generate more than $500 billion in revenue.nnNot every American will have both their medical and drug benefits managed by the same company. But many more will in the years to come. These integrated companies have more information about their customers and more ability and incentive to manage the totality of their health spending.nnUnitedHealth is already all-encompassing, with its continuing investment in everything from ambulatory surgery centers to physician groups. CVS and Aetna — which will add retail pharmacies and primary care clinics to the equation — could have an unprecedented role in patient lives. Read More >>nnCLICK HERE to view original article in it’s entirety, including informational charts, graphs and author info.
In celebration of National Doctors Day, we would like to honor and recognize the physicians who have made a difference in our lives and local communities. Doctors of all specialties do so much for us and we don’t often realize how much they contribute to our daily activities and overall well-being. From minor scrapes and viruses, to complete home health care when needed, doctors provide valuable information that allows us to take care of ourselves and our families. National Doctors Day is celebrated by showing special appreciation for physicians and displaying red carnations, the symbolic flower of Doctors’ Day.nnWhile we are thankful for all doctors, we would like to send a special “THANK YOU” to our clients as we celebrate YOU on this special day!
CTCi group, the center for transformative coaching, is offering two sessions to help management teams and other professionals understand the importance of effective management. These web based sessions are developed in a way to help you and your employees succeed!nnnRead more about each individual program and click the link below each description for more information or to register.nn nn
Health and Human Services Secretary Alex Azar said Monday that value-based healthcare “needs to accelerate dramatically” in the U.S., calling for a range of changes to the healthcare system that he said would provide more tools to give consumers more control over their care.nn“This is no time to be timid — today’s healthcare system is simply not delivering outcomes commensurate with its cost,” said Azar, speaking at the public policy conference for the Federation of American Hospitals in Washington.nnAzar’s speech focused on value-based care, an approach in which doctors and hospitals are reimbursed by private health insurance and the government for how well patients emerge after a medical procedure versus the amount of care provided. That method was also cited by the Obama administration as a priority, and Azar during his speech called out that work, saying that value-based care was “taken seriously by President Barack Obama’s administration as well.”nnHe noted that while policymakers had been discussing such potential changes since the early 2000s, the shift was just getting started and was “still far from reaching its potential.”nnHe laid out areas the Trump administration plans to emphasize, promising to deliver “disruptive” changes in healthcare, including giving consumers more control over their health information, encouraging more transparency from healthcare providers and payers, using experimental models in Medicare and Medicaid, and removing government burdens.nn
Azar stressed the need for patients to better understand what medical care will cost them, citing examples such as knowing the price of a medical procedure or a prescription drug. He also cited examples in which providers spend an extensive amount of time reporting their outcomes, which can limit the amount of time they can deliver care.nn”Our current system may be working for many, but it’s not working for patients and it’s not working for taxpayers,” Azar said.nnAzar was sworn in as secretary five weeks ago and will be speaking at the policy conference for America’s Health Insurance Plans on Wednesday. Chip Kahn, president of the Federation of American Hospitals, called Azar the “perfect pick for the times” in remarks ahead of Azar’s speech.nnHe reiterated his overall priorities Monday were to focus on value-based care, combat the opioid crisis, bring down the cost of prescription drugs and to lower the cost of health insurance for people who do not receive coverage through the government or through work.nn“This administration, and this president, are not interested in incremental steps,” Azar said. “We are unafraid of disrupting existing arrangements simply because they’re backed by powerful special interests.”nnThis 
No is a request for informationnIn all things inter-personal, No means No. In managed care contracting, No is a request for information. In other words, if you have a reasonable request which makes sense, don’t take no for an answer. It may take time, it may take a different approach but stay on it, fight for what you believe in and keep working it until you get the desired result.nn Welter Healthcare Partners does Managed Care Contracting and we do it well. We interpret “no” from the health Plans as a request for Information.nnHealth Care Provider’s IncomenYou have to find ways to “make money while you sleep.” Being a health care provider is a great profession and all the rest of us appreciate your education, experience, skills and talents but in the current fee-for-service world and even most risked based reimbursement models you have to be working to get paid. I don’t care how much you make, it is not enough if you only get paid when you actually are working.n
About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare Partners