Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

Major Boston Health Care System To Acquire Local HMO

Kingkong.jpg (480×320)Partners Health Care (the dominant provider network in Greater Boston) and Neighborhood Health Plan (a local mostly-Medicaid HMO) just announced that the former intends to acquire the latter, and maintain it as a separate operating entity.  No money will change hands between the parties, but an unspecified amount of money will be given by Partners as grants to community health centers where NHP members receive much of their health care services. Gary Gottlieb, CEO of Partners, graciously allowed that it would not seek to interfere with the current referral patterns of NHP members to the two local safety-net hospitals (which get disproportionate share hospital payments; Partners hospitals do not).

The deal is contingent on several layers of regulatory review, including review by the Commonwealth’s Attorney General’s Office, which has reported on Partners using its market power to extract high rates of reimbursement from payors that do not correlate to a higher quality of care relative to others around town.

See the NHP presser and fact sheet, and the Boston Globe story on the deal announcement.

So, is the motivation for the affiliation (a) Partners offering a helping hand to a Medicaid HMO and a network of community health centers as part of its mission, (b) a rational reaction to market forces in the face of health reform by Partners, providing a fig leaf for Partners as it faces further scrutiny in the marketplace by regulators and others, (c) an ace in the hole that may be used to win a future hand (e.g., when state, Federal or commercial reimbursement rates get cut further, and Partners can claim it’s a special case) or is it (d) simply part of the Partners unified field theory of the marketplace whereby it seeks to extend its influence over payors and non-Partners providers and position itself for future success as an ACO or other as-yet-undefined new type of provider network with a payor kicker?   Probably a bit of each.  The community health center move is just the latest in a years-long chess game of CHC affiliations.  The HMO acquisition is something new, though, and will bear watching.

For more on Partners, the Massachusetts experiment and Massachusetts Attorney General Martha Coakley, see this post on global payments and earlier Massachusetts Attorney General and special commission reports and other resources linked to from the post.

This news comes on the heels of news of some fancy footwork by John Kerry that tied all Massachusetts hospital Medicare payments to a wage index related to Nantucket Cottage Hospital (a high-wage hospital on an island) which is part of Partners.  (A few other states benefited from this ACA amendment as well.)  This being a zero-sum game, the $275 million a year extra income flowing to Bay State hospitals comes out of the hides of other states’ hospitals. They are less than thrilled.

The continuing question as all of this shakes out is — or perhaps should be — whether the Partners-NHP deal advances Don Berwick’s triple aim: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*


You may also like these posts

Read comments »


Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »