Some of the Hudson Valley region’s largest physician groups recently partnered with regional and national companies amid concerns that federal regulators will increase patient costs due to medical consolidation.
Part of a group of more than 2,100 providers serving more than 1.6 million patients throughout the Hudson Valley and New York City, CareMount Medical recently became one of the nation’s largest owners of a group of 53,000 providers. I have finalized my participation in an Optum. doctors nationwide.
And earlier this year, Westmed Medical Group, which has nearly 500 doctors and 1,500 clinical staff in Westchester County, New York and Connecticut, acquired Summit Health, a medical network with more than 12,000 workers in five states. I participated in.
Meanwhile, officials are moving to block some hospitals in other states and other mergers involving several major health care companies, including Optum, a deal that violates antitrust laws and raises patient prices. Allegedly threatening to withdraw
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How the Hudson Valley Healthcare Merger Evolved
Amid controversy, the many mergers in the Hudson Valley over the past decade have avoided such cost increases because there are still enough providers to fuel fierce competition for patients, said the president of the Suburban Hospital Alliance. said Wendy Darwell, CEO and CEO.
“It’s really been driven by the need to achieve some cost savings through economies of scale and be able to deploy resources more efficiently,” Darwell said, taking over Hudson River hospitals and providers. You’ve dealt with a wave of healthcare systems in the New York City area. Valley since 2010.
Darwell added that another key element of the merger would be to allow providers to negotiate reimbursement rates jointly with health insurers, which could limit price increases for patients.
In other words, Darwell says:
However, the competitive market in the region is likely to drive other healthcare system spending on hospital construction and cutting-edge medical technology, which impacts healthcare costs, driving up patient prices.
Additionally, conflicts between the larger healthcare system and health insurance companies could disrupt access to doctors within a patient’s network, forcing them to seek out new doctors or out-of-pocket medical costs. .
Much of healthcare integration and spending can be traced back to policy reforms and integration incentives under the Affordable Care Act of 2010. However, some experts have recently expressed concern that the extent of consolidation is leading to higher healthcare costs across the industry.
In recent years, many health insurers have increased deductibles, premiums, and other costs for everything from rising drug prices to COVID-19 pandemic-related costs and inflation, causing patients to pay for healthcare. The amount is also increasing.
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Why authorities are trying to block healthcare mergers
Currently, the Biden administration and the Federal Trade Commission (FTC) are pushing for some health care mergers, especially in markets where competition is restricted or where companies have too much control over key services such as medical technology providers. We are strengthening our efforts to prevent
A federal lawsuit seeks to block the acquisition of Change Healthcare by Optum and the owner of Optum’s holding company, UnitedHealth Group, alleging that the deal would stifle competition. The office of New York State Attorney General Letitia James is involved in the case.
“Amid a devastating pandemic, it is concerning that United is taking actions that are driving up healthcare costs and degrading the quality of service it provides to New Yorkers and patients across the country,” James said in a statement about the lawsuit.
Optum has contested the lawsuit’s allegations as unfounded, stating instead that the merger will “benefit the entire healthcare system by increasing efficiency and reducing friction, resulting in reduced costs, patient, It will improve the experience for payers and providers.”
Optum Tri-State Regional CEO Dr. Scott Hayworth detailed the renaming of CareMount to Optum in a recent email to patients, but emphasized that it remains regionally driven.
Hayworth, who previously headed CareMount and its predecessor, Mount Kisco Medical Group, said patients “have a larger regional footprint and greater access to the high-quality care and care they know and trust.” We will continue to receive experience,” he added.
CareMount’s rebranding announcement included two other community health groups joining Optum: ProHEALTH NY and Riverside.
Meanwhile, two major New Jersey health care providers dropped plans to merge in April, ending more than a year-long legal battle with the FTC. The case joins his other high-profile FTC challenges to healthcare mergers in recent years, as the industry faced a reality of even greater opposition to consolidation.
Still, attempts by some medical networks to continue expanding and consolidating in competitive markets such as New York City and the Hudson Valley have seen similar gains from the FTC, including New Jersey-based Summit Health’s partnership with Westmed. avoiding the backlash of
“By leveraging Summit Health’s expertise in coordinated value-based primary and specialty care, the newly strengthened organization will create a uniquely accessible and comprehensive model of care delivery that will contribute to the health of the community. We can play a bigger role,” said Anthony Viceroy, CEO Westmed, in a statement about the partnership earlier this year.