What Anthem-Cigna merger rejection means for your practice
"Big health insurers are zero for two when it comes to mergers, with federal courts delivering a resounding message that supports a competitive healthcare marketplace,” said Robert W. Seligson, PAI president, in a prepared statement. “This merger would have resulted in higher prices and diminished innovation, which is bad news for patients already coping with narrow provider networks and increased out-of-pocket costs. Competition helps keep premiums in check and allows more choice in which physicians patients choose to see for their medical care. This decision is a clear win for patients."
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With the merger off the table, competition for customers will continue between the two corporations. This means that primary care physicians will retain the opportunity to negotiate on behalf of their patients, notes Randal Schultz, JD, a partner in the law firm of Lathrop & Gage LLP in Kansas City, Missouri, and chair of the firm's Healthcare Strategic Business Planning Practice group.
“By eliminating that potential market power, you have more room to have primary care doctors have some kind of voice in the marketplace,” Schultz says. The blocked merger signals that it’s time for doctors to think seriously about new delivery models that will reduce costs in the system as a whole, he noted.
“We want to keep that corridor open for physicians, between historical costs and current costs,” he says.
The health insurance system today drives cost to the employer, who provides a choice of insurance providers to its workers, Schultz says. When a primary care doctor finds ways to reduce the patient’s healthcare costs—by treating a patient outside of the hospital, reducing the length of hospital stays, or foregoing unnecessary tests, for example—the patient and the employer both save money.
“That money should go right to the primary care doctor,” says Schultz.