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News Clips
Healthcare Dive (7/9) Insurer ownership of U.S. primary care practices is small but growing: study – In 2023, payer-operated practices accounted for 4.2 percent of the national Medicare primary care market by service volume, up from 0.8 percent in 2016. It’s the first concrete estimate of insurer ownership of physician practices nationwide, and suggests that vertical consolidation is being driven by the potential for profits in nudging MA members to owned clinics, researchers said. Critics are concerned that vertical integration may allow insurers to steer patients toward their own doctors at the expense of other practitioners, disadvantage rival insurers by shutting in-house providers out of their networks and allow other anticompetitive behavior, potentially leading to higher prices and less choice for patients.
NEJM (7/2) The Corporatization of U.S. Health Care — A New Perspective Series – This issue launches a new Perspective series called “The Corporatization of U.S. Health Care” to delve into trends and draw out their ramifications for physicians, patients, and health. It begins with an article by Erin Fuse Brown, laying out some essential definitions — including what’s meant by “corporatization” — and providing a snapshot of the current landscape. Then, each month, one or more experts will explore a specific aspect of corporatization, its effects on various key constituencies, and, where possible, what could or should be done to mitigate its negative consequences while sustaining and revitalizing a health care system capable of improving health and fostering a high quality of life for everyone.
AMA (6/30) Medicare Basics series: Advancing value-based care with alternative payment models – Many years after MACRA’s passage, it has become evident that changes are needed to realize the robust pathway to APMs that Congress envisioned. These critical changes will help improve patient outcomes and reduce unnecessary Medicare spending. Specifically, Congress needs to:
- Reauthorize crucial incentive payments to increase physician participation in Advanced APMs which expired at the end of 2024.
- Make participation thresholds for earning the incentive payments more flexible and realistic, reversing abrupt increases that took effect in 2025.
- Update criteria for adopting and expanding Medicare APMs. Criteria for achieving Medicare savings within a short time span have led multiple medical home and other models to be terminated and limited adoption of specialty models. Meaningful pathways are needed for APM proposals developed by stakeholders to be implemented in Medicare.
Avalere (6/25) White Paper: Health System Consolidation and Employer-Payer Considerations– Over the last several decades, the United States healthcare landscape has seen a significant shift of formerly independent physician practices joining health systems, as well as mergers and acquisitions between health systems. At the same time, physician reimbursements from Medicare have declined 33 percent from 2001 to 2025 after adjusting for inflation in practice costs—further exacerbating the challenges physicians face to remain independent. Comparative analyses of Medicare and commercial data highlight that non-hospital, multispecialty groups can offer more cost-effective, coordinated care, reducing overall healthcare expenditures.
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