Challenges and Opportunities Facing Payors and Providers – Part II

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Dr. John Rowe continued the lively discussion on the issues with healthcare systems forming their own health plans.  He noted that forming a health plan is very complicated and involves a deep knowledge of the domain, operational, financial and legal risk, a large amount of financial capital and a complex regulatory environment.  He discussed how each of these issues pose significant challenges to healthcare systems forming their own health plans.

Dr. Rowe also expressed concern about the impact of recent Salter Medical Group case on ACOs and expanding healthcare systems.  In Saltzer a federal judge in Idaho ruled that providers consolidating in pursuit of realizing the goals of healthcare reform are still subject to conventional antitrust restrictions.   Dr. Rowe also noted that some of the changes currently in the healthcare environment may not continue, such as the robust expansion of narrow network exchange plans, while other trends, such as the expansion of Medicaid will likely continue.  Dr. Rowe concluded by stating that healthcare pricing is indeed coming down and that the focus of the energy behind many of the current and future changes in healthcare will be with the providers.

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