Hackensack Meridian and JFK cement merger

(Updated Jan. 5, 2018)

Hackensack Meridian Health and JFK Health finalized their merger to create a combined entity with 16 hospitals throughout New Jersey, the companies announced Wednesday.

Executives of the Edison, N.J.-based systems said the marriage would allow them to expand patient access and better deliver preventive healthcare. The merger will bolster a combined ambulatory network of 160 facilities, reflecting the importance of more convenient outpatient settings where patients can get more affordable and efficient treatment. The combined organization, which has minimal overlap in services and geography, also can expand its neurological and cancer service lines, executives said.

"We are in a major pivot to population health and knew we needed scale to meet the needs of the community, and Hackensack fit that order," Raymond Fredericks, CEO of JFK Health, told Modern Healthcare in May after a definitive agreement was signed. "This will help us continue to keep a strong, robust hospital in Edison and offer a great compendium of services close to our residents' homes."

Like many other states, New Jersey is home to a rapidly consolidating healthcare market. Systems are looking to grow their networks to expand their patient base and leverage costs as well as share risk through provider-insurer partnerships. While executives claim these mergers will allow them to become more efficient, critics warn that concentrated markets could ultimately raise healthcare costs.

Hackensack Meridian was formed after a 2016 merger of Hackensack University Health Network and Meridian Health, linking a total workforce of 28,000 employees across 13 hospitals, including two academic medical centers, two children's hospitals and nine community hospitals. The combined health system, which is a partner with the Memorial Sloan Kettering Cancer Center, plans to launch a Seton Hall University-affiliated medical school in 2018.

While Cooper University Health Care recently dropped plans to buy three Trinity Health hospitals in Camden and Trenton, RWJBarnabas Health—the result of 2016 Robert Wood Johnson Health System and Barnabas Health merger—is still pursuing a partnership with Rutgers University. RWJBarnabas signed a letter of intent in July to merge with Rutgers and its health group, which would form New Jersey's largest academic healthcare system including a 2,500-practitioner multispecialty group, executives said. RWJBarnabas Health also partnered with Children's Hospital of Philadelphia in January to build a network of pediatric facilities.

Leslie Hirsch, president and interim CEO of New Brunswick, N.J.-based St. Peter's HealthCare System, which includes the independent St. Peter's University Hospital, said consolidation is making it harder for an independent hospital to survive.

"We are in probably one of the most competitive markets in the state," Hirsch said, adding that 58 of New Jersey's 71 acute care hospitals are owned by systems that have at least two hospitals. "There has been a lot of competition for physicians."

But the larger question is how consolidation of the healthcare industry is going to reduce the cost to the consumer and the jury is still out on that, he added.

Hackensack Meridian and JFK executives say their combined ambulatory and home healthcare networks will allow them to reduce costs and improve quality by bundling care. But fewer competitors mean hospitals can secure higher price concessions in their negotiations with insurers, leading to at least 15% higher costs in consolidated markets, studies have shown.

While the deal will give the combined organization some regional leverage in negotiations with payers that are also consolidating, it will also help offset some of the ongoing margin pressure, said Eb LeMaster, a managing director at consulting firm Ponder & Co.

"Whether it's a new Medicare Advantage product or more advanced value-based payment models, those are difficult to pursue on $500 million (of JFK's revenue)," he said. "Now with $5 billion (in combined revenue), they can take on more risk."

Hospitals and health systems with $500 million to $3 billion in revenue will continue to consolidate, and there may be more opportunities for New Jersey providers to partner with organizations in the Philadelphia area, LeMaster added. Hackensack Meridian already has a joint venture Medicare Advantage plan with Geisinger Health System, which is based in Danville, Pa.

Hackensack Meridian's network now totals 16 hospitals spanning Bergen to Ocean Counties with more than 33,000 employees, including 6,500 physicians. Executives said they will bolster their case management operations as well as community partnerships with civic organizations to address issues like food insecurity. The merger announcement also came with a $12 million expansion of the cardiac catheterization lab at JFK Medical Center, which is expected to be completed this year pending regulatory approval.

"We have taken 350 care case managers and focused them on a system level rather than a hospital level," said John Lloyd, co-CEO of Hackensack Meridian Health. "So if a patient leaves our facility, they will always have the phone number of a case manager."

But it will take time for these large organizations to optimize integration, if plans come to fruition at all, Hirsch said.

"Just because you are large doesn't mean you're efficient or well-orchestrated," he said. "Independent hospitals not only have these challenges in how to remain relevant in cost and quality, but the large systems will have these struggles as well. A lot of shakeout will occur."

An edited version of this story can also be found in Modern Healthcare's Jan. 8 print edition.