Traditionally, it would be illegal for competitors to jointly negotiate prices with insurers—what's known as price-fixing. And the Federal Trade Commission has declared a special focus on healthcare in recent years.
But the FTC also has long allowed competing providers to coordinate prices provided they can show that they are truly working in concert to improve care. That would include jointly buying health-information technology, setting common clinical protocols across different providers, and sanctioning people or entities that break the rules.
“Collaboration leads to innovation,” said Patricia Maryland, president of healthcare operations and chief operating officer of Ascension Health. She said the organizations were looking forward to working together on population-health and coordinated-care models that require sophisticated analytical infrastructure. The new group also plans to disseminate innovations across its service lines, including ways to address public health concerns and address multiple chronic conditions in patients.
“Instead of creating a financially integrated model, what we're really trying to do is to virtually achieve the same thing, using a collaborative partnership model,” said Kevin Sears, vice president for payer and product innovation at CHE Trinity.
The antitrust analysis doesn't end with integration, however. “The second question you would ask is, do you have market power?” said Douglas Ross, a partner with Davis Wright Tremaine in Seattle. Market clout would be the ability to force insurance companies to contract with Together Health, which would give the network the ability to unilaterally raise prices because it would be a “must-have” provider.
Officials with Together Health say that won't be an issue for them for two reasons. First, only a small number of Together Health providers overlap in geographic markets. And second, participating providers will still be able to negotiate contracts with insurers outside the network.
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