Stephen Timoni was recently interviewed by Karen Appold of Managed Healthcare Executive regarding significant changes on the horizon which are expected to affect both health insurers and providers alike. Many are the result of a shift toward value-based care, a move toward decreased care in hospital settings, technological advances, and other forces.
Along these lines, Timoni says that consolidation has been motivated by the evolving and challenging commercial and government reimbursement models which include lower fee-for-service payment rates, value-based payment components, and incentives to move care from inpatient to outpatient settings. “Basic economic theory suggests that consolidation of hospitals and physicians enables these combined providers to charge higher prices to private payers as the result of a lack of competition,” Timoni says. “Likewise, combined insurers are able to charge higher premiums to their subscribers.”
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