Healthcare Consolidation Impacting Market Competition, Consumer Choice

September 30, 2021 - Healthcare mergers and acquisitions make sense from a business perspective, but they are causing industry stakeholders and federal officials to ask questions about market competition and consumer choice.

Payer Consolidation Increases, Further Limiting Consumer Options

Health insurance industry consolidation continued to increase, restricting consumers’ options for coverage, according to a new American Medical Association report.

AMA found that nearly three-quarters of all metropolitan statistical areas—or 280 areas—fit into the highly concentrated category. The mean Herfindahl-Hirschman Indices for preferred provider organizations, health maintenance organizations, point-of-service plans, and exchange plans combined was 3,494 and the median HHI for these plans was 3,178.

More than nine out of ten markets (91 percent) had one insurer holding at least 30 percent of the market share. And 46 percent of the markets had one insurer holding at least 50 percent of the market share. Moreover, AMA found that the rate of consolidation was increasing, continuing a trend that the organization emphasized in its 2020 report on the insurance industry’s consolidation. READ MORE

Hospital Groups Push Back On FTC Over NJ Hospital Merger

The Federal Trade Commission challenged the proposed acquisition of Englewood Healthcare Foundation by Hackensack Meridian Health, Inc. last December. The federal agency argued that the merged health system could control half of the inpatient general acute care hospitals in Bergen County, New Jersey, leaving payers with few alternatives for care and possibly higher rates for that care.

However, the American Hospital Association and the Association of American Medical Colleges challenged FTC’s arguments in a recent friend of the court brief.

The FTC’s approach to defining the relevant geographic market in this case conflicts with settled law and economic principles, as well as business reality,” they wrote to the US Court of Appeals. “In-deed, the FTC is attempting to do something that it has never directly attempted in hospital merger litigation—define a relevant geographic market based on where ‘commercially insured patients’ live—'in Bergen County.’” READ MORE

Pfizer Commences Trial for COVID-19 Treatment Following Exposure

Pfizer recently announced the start of a Phase 2/3 study to evaluate its COVID-19 treatment in combination with ritonavir to prevent coronavirus disease.

The randomized, double-blind EPIC-PEP study will evaluate PF-07321332 with a low dose of ritonavir in 2,660 healthy adults 18 years of age and older living in the same household as an individual with confirmed symptomatic SARS-CoV-2 infection.

Patients will either receive PF-07321332/ritonavir or placebo twice daily for five or ten days. Researchers will observe safety and efficacy to prevent COVID-19 and its symptoms through Day 14. READ MORE

Telehealth Adoption for Strokes Not Tied to Improved Outcomes

Telestroke adoption in hospitals did not produce any changes in patient outcomes or in stroke systems of care, according to a study from researchers at Harvard Medical School and other health systems.

Researchers compared 593 hospitals that adopted telestroke between 2009 and 2016 with 593 control hospitals that did not offer telestroke services. They identified stroke and transient ischemic attack (TIA) patients using Inpatient and Outpatient Standard Analytic Files from 2008 to 2018 for Medicare beneficiaries.

The telestroke hospitals and the control hospitals both had similar changes in their mean annual stroke volumes during the post-implementation period. The telestroke hospitals saw a decrease of 79.6 to 76.3 patients per year and the control hospitals saw a decrease of 78.8 to 75.5 patients. Previous studies have revealed the opposite, with telestroke adoption showing an association with a decrease in the number of patients that transfer hospitals, the researchers noted. READ MORE

Patient Mobile Patient Portal Use Lags Behind mHealth Apps

People aren’t using a smartphone patient portal nearly as much as they are using other mHealth apps on their mobile phones right now, but the potential is there for smartphone patient data access to enable more patient engagement, according to a data brief from the ONC.

Currently, 61 percent of patients are accessing the patient portal from their computers only; 22 percent are looking at the patient portal on their smartphones only and 17 percent are using both devices to view their medical records.

Meanwhile, patients are much more enthusiastic about using their smartphones to engage with mHealth apps, the data showed. Fifty percent of patients said they have an mHealth app downloaded onto their smartphones, and of those patients, 85 percent use the app at least once a year. Most (71 percent) of the folks using a smartphone app use it to track progress toward a health-related goal. Far fewer use it to communicate with their healthcare providers or make a healthcare decision, coming in at 51 and 52 percent, respectively. READ MORE

Genetic Mutations Hold Key to Cancer Prevention

A recent study indicated that genetic mutations in blood cells caused by smoking and aging-related changed could be risk factors for a rare type of blood cancer that impacts immune cells. The findings could lead to new ways to diagnose and prevent the disease as well as advance precision medicine efforts.

The team of researchers used next-generation genome sequencing to analyze 537 genes in 27 patients with AITL or PTCL. The researchers searched for genetic changes that could lead to T-cell tumors and secondary cancers.

Through the analysis, they found that about 70 percent of patients had mutations in precursor cells, most likely stem cells, in the bone marrow that could lead to a growing number of blood cells with these mutations and the early development of T-cell tumors. The mutation on the precursor cells is thought to be associated with aging. READ MORE