September 2020 Volume 9 Issue 13
Providing Current Information on

Health Insurance Industry Issues and Legislation

The Impact of Horizontal and Vertical Provider Consolidation
Provider consolidation continues unabated and, as a result, prices for health care
just keep rising. Research shows that consolidation is leading to significantly higher
prices for private insurance, but not an improvement in quality for patient. Prices rise
when hospital mergers or acquisitions take place between hospitals within the same
market, in the same state or even between states with prices continuing to increase
for 2 or more years after the merger or acquisition takes place. Combining physician
practices has led to 14%-30% higher prices in the markets with the highest practice
concentrations versus those with the lowest. Finally, based on a national research study,
physician - hospital integration has resulted in private insurers paying 14% more for the
same services.
Fighting Those High Dollar Claims
As vertical and horizontal consolidation continues and the price of
services keep increasing, it is more important than ever to have highly skilled,
experienced specialists, like HHC's attorney negotiators, fighting to ensure you are
paying only the appropriate amount for the services received. It's also essential to
have nurse experts, like those used by HHC, to comb through claims line by line to
ferret out costly unbundling, duplications, inappropriate charges and other errors.
Mental Health and Substance Abuse Driving Up Health Care Costs
It makes economic sense for employers, health insurers and health care providers to
significantly increase access to effective and affordable in-network specialty health
providers. It also makes sense to focus on detecting behavioral issues and tracking clinical
outcomes as early as possible. These are two of the conclusions of a just completed
study conducted by Milliman. More than half of the 10% of patients who account for
70% of total health spend suffer have either mental health or substance abuse disorder
issues. However, less than $68 of the total health care costs for these patients go toward
behavioral treatment for half of these highest cost patients.
Healthcare Costs to Jump Up in 2021 Amid Coronavirus Pandemic
Employers expect the cost of health care benefits surpass $15,000 per employee in
2021, an increase of 5.3% slightly higher than the average increase in pre COVID-19
years and much higher than this year's 1.3% increase. Expanded commitments to
virtual health options and improved mental health and emotional well-being benefits
are all expected to contribute to the increase. The wild card in the cost estimate is the
pandemic's effects on both preventive and elective care, as wells as potential charges
for Covid-19 related expenses.
Three Star Preferred Provider Program Additions
Alta Vista Integrated Life Services
Gig Harbor, WA 98335

Drumright Regional Hospital
Drumright, OK 74030

Dascochrist Home Medical Equipment
Cincinnati, OH 45227

Christina Claywell
Glen Carbon, IL 62034

Eyes on Fulton
Chicago, IL 60607

Compression Solutions Inc.
Tulsa, OK 74120

Apollo Home Care of Kansas Inc.
Topeka, KS 66604

Luis Lopera
Mundelein, IL 60060

After Hours Clinic Inc.
Jasper, AL 35501