January 11, 2016

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HEALTHCARE ROUNDTABLE

January 11, 2016

BENTZ: Specifically with the mergers going on, the buying power of a lot of our companies and then the employees that work for them is changing the dynamics, it's changing the access points and how we're going to be negotiating benefit options. I think we're going to see a lot more self-funded plans coming back around, especially with a lot of these mergers because we're going to see fewer competitors in the market than we've had in the past. Competition is good in healthcare, specifically here in Utah. So it's just going to change the dynamics. And I think it'll steer it more toward more the consumer-driven and the high-deductible plans.

BELL: I agree—there will be fewer options for employers as a result of it. I can't disagree with the fact that it's a free market system and if there's interest in buying and merging, that's OK. But there are fewer options. Aetna doesn't probably have a tremendous amount of business here, so to acquire Altius was a little less impactful. We're waiting to see what it might mean for Regence, though, as a result of the Anthem merger.

TANNER: For providers, the consolidation means we just have less people we have to negotiate with, and maybe some different tactics that the insurance companies are deploying with the shift in healthcare. We see more analytics being applied to the delivery of care. And so perhaps larger organizations, larger insurance companies can put some resources toward that game. But that's yet to be seen.

McOMBER: From the physician perspective, we've had a lot of concern expressed about some of the consolidation that's happening. We haven't seen as much in Utah, but we're starting to see it. But just the wave across the country is concerning to physicians.

What we are seeing in response to some of this is physicians who are looking for other options. Because if you can't participate in an insurance plan or if there's consolidation, if you're blocked out of participating, which is sometimes what we see happening, they're looking for other options for how they're going to care for patients.

What we are seeing are some creative ways for them to participate with patients that actually does not include insurance. We're seeing some concierge services starting up in Utah. We're seeing telemedicine that does not include insurance. Some of that's probably good, but some of it may be bad. But they're looking for other ways to do care.

You get too big, too. Prices actually go up, not necessarily down. When Sutter Healthcare in California merged last year and got bigger, the prices went up 20 percent. You see that in insurance companies, too. We want to be careful when we're looking at consolidation that we don't get so big that prices actually go up and we reduce competition.

CONNER: We're running an exchange that's really based on having competition and being able to allow small employers to come in and choose from multiple plans. If that ends up being one or two, then there's really no competitive marketplace in which they can shop to help drive down those prices. So with these mergers, we see they are stopping a lot of that competition and the pricing.

These mergers aren't like overnight activities. It takes a long time for them to do the mergers. And the consumers and the members of each of those respective plans are stuck in limbo for many years. The local people can't make decisions because their corporate is holding back on making any future plans on things. That impacts a lot of people's lives in between.

SLONAKER: The other marketplace we're dealing with in Utah now is the federal exchange. I just want to report that there are six insurers offering 101 plans. That's a little bit of growth. So from that perspective, maybe there is a little more choice for consumers. It’s a small glimmer of hope perhaps, that we are seeing more and more insurers want to participate in the federal exchange. And maybe that will provide downward pressure on prices eventually.

 One of the things that's happened in recent years is the growth in accountable care organizations. How do you feel those are going and how will they impact healthcare in the future?

BARLOW: The overall opportunity to affect healthcare is quite positive because it's causing everyone to think about patient-centric care. How do you engage the patient more? How do you find new delivery vehicles to provide a better product at a lower price?

It's been a rough journey simply because it's new. We're in a schizophrenic world where part of the business is in that side of work and part of it is in the normal fee-for-service environment, which makes it very difficult. But the biggest challenge has been simply getting the massive data sets that come with it figured out. We started with the federal one in 2012, and every few months there's a surprise of information that comes with that experience. We've got five commercial ACOs as well that we've been practicing.

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