The next chapter of the ‘Perils of Pauline’ saga that is the CVS-Aetna merger won’t commence until June, as it turns out, but already the amici curiae are piling up on both sides. Judge Richard Leon of the US District Court for the District of Columbia has been lining up the witnesses he’ll be hearing from, both for and against.
On the ‘anti’ side, testifying that the settlement agreement would be anti-competitive and not in the best interest of consumers, the American Medical Association (AMA) had called in three professors, the AIDS Healthcare Foundation three, and Consumer Action and the US Public Interest Research Group (PIRG) one. On the ‘pro’ side, put forward by CVS and for the Department of Justice, are five witnesses, healthcare executives and government consultants, who will testify that actions taken by CVS and DOJ will preserve competition and benefit consumers.
Certainly as we clock the ninth month after DOJ approved the merger and the companies have closed the deal, the drama continues, as Judge Leon continues to get coverage and the merger continues to be held up in this highly unusual proceeding. HealthLeaders 22 April and 7 May.
Update 13 May. The DOJ is challenging the three AMA witnesses, saying that they will be broadening the hearing beyond the settlement agreement which is what the review by Judge Leon is supposed to be about. On the other hand, the judge has already stated that the settlement covers “about one-tenth of 1%” of the merger, so he is already staking out a much larger territory. The AMA, of course, is quite pleased with the opportunity. Is this hearing pushing the envelope of judicial overreach in this judge’s interpretation of what a District Court can do under the Tunney Act? We can only wait and see. Healthcare Dive 13 May. Our coverage of the hearing to date here.
Update 14 May. DOJ of course lost its fight with Judge Leon to limit the scope of the hearing and the AMA witness testimony, with the judge stating it is “essential” to understand how PBM affects Medicare Part D drug plans, though Aetna divested itself of the latter at DOJ’s direction. Both sides have three approved witnesses each for the three-day hearing. The ‘antis’ are Neeraj Sood (AMA), Diana Moss (Consumer Action/PIRG) and Michael Wohlfeiler (AIDS Healthcare foundation). The ‘pros’ are Alan Lotvin (CVS Health), Terri Swanson (Aetna) and Lawrence Wu (NERA Consulting). Healthcare Dive 14 May
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/04/Thomas.jpg” thumb_width=”150″ /] Breaking News. Not with a bang, but a whimper.
Late Wednesday 8 Feb, the anticipated decision derailing the $54 million Anthem-Cigna
merger was released by the Federal District Court, District of Columbia. Judge Amy Berman Jackson’s decision denying the merger was very much along the anti-competitive and anti-trust rationales contained in the 19 January advance report
by the New York Post
. There’s little that hasn’t already been explored in our prior reports, so we will leave the rehashing to sources like CNBC
. The general consensus is that the four Big Payer Merger participants (Aetna
merger denied [TTA 24 Jan
]) will be moving on, perhaps to their advantage as most of the premises for merging, based on ACA’s effects, are expected to change, drastically.
Cigna must also be relieved after its reported ‘merger remorse’ after too many rumored disagreements with Anthem. According to Bloomberg, Cigna is sitting on $7 to $14 billion deployable capital, with the high end including extra debt. (Does this include the $1.85 bn breakup fee that Anthem owes to Cigna? Stay tuned on how Anthem tries to get out of this.) And the American Medical Association is beyond delighted (release).
Of course, there’s a lot of speculation about all that loose cash being deployed on new merger targets, which include the Usual Suspects of Humana, WellCare, Centene and Molina. Some free advice: all these companies should, for the next year, sit quietly and breathe deeply (as many employees who would be redundant in any merger are). They should also take care of business (TCB!), refocus on serving their policyholders, make their processes far less onerous on providers, and let it all shake out rather than rushing out to find out Who To Buy. (New Attorney General Jeff Sessions was sworn in this morning, and many changes are coming in both healthcare policy and the judiciary.) Also Neil Versel’s pointed take in MedCityNews.
In line with my fellow editor, forgive this editor engaging in a little nostalgia – going back to 2006, when the Whole System Demonstrator was a still a wonderful idea, before the competing forces of academia and management consultancy put short-term financial gain before long term patient outcome improvement. Those were the days when we genuinely believed that recording vital signs was what it was all about.
Move on nine years and it’s clear from the American Heart Association review referred to in this column recently, and subsequent articles, that one key success factor is drip-fed education. To quote:
“The amount of information that must be conveyed and the support that is necessary to counsel and motivate individuals to engage in behaviors to prevent CVD are far beyond what can be accomplished in the context of face-to-face clinical consultations or through traditional channels such as patient education leaflets,” the researchers say. “Mobile technologies have the potential to overcome these limitations and to transform the delivery of health-related messages and ongoing interventions targeting behavior change.”
This is underlined by a recent study of attempting to control hypertension using just text messaging, which was far from an unqualified success.
Another major driver of course is cost saving, as demonstrated by (more…)
Blues feeling Blue about…The Anthem-Cigna merger, finalized last week (but yet to be approved by the US and likely the UK Governments as Cigna issues policies there), gives them bragging rights over the Aetna-Humana merger and Optum/United Healthcare in their covering of 53 million US lives as the largest US health insurer. Unnerved is the Blue Cross and Blue Shield Association, of which Anthem is a part of with the Anthem and Empire Blue Cross plans plus others in a total of 14 states. But Anthem also competes with ‘the Blues’ in 19 additional states where it markets under a non-Blue brand, Amerigroup, primarily for Medicare and Medicaid (state low-income coverage). Many of the Blues are non-profit or mutual insurers; many are partial or single-state, like Independence, Capital and Highmark (PA/DE/WV) in Pennsylvania and Horizon Blue Cross of New Jersey. Their stand-alone future, not bright since the ACA, now seem ever dimmer in this Editor’s long-time consideration and that of Bruce Japsen writing in Forbes. Also Morningstar considers Anthem’s overpaying and the LA Times overviews.
Walgreens Boots Alliance, another recent merger of quintessentially American and British drug store institutions, named as its interim CEO Stefano Pessina. He previously ran Alliance Boots prior to the merger and is the largest individual shareholder of WBA stock with approximately 140 million shares, so one cannot call it a surprise. At a youthful 73 (see video), one assumes he also takes plenty of Walgreens vitamins and uses Boots No 7 skin care. Forbes.
Updated: The big EHR news is the US Department of Defense announcing the award of its Defense Healthcare Management System Modernization contract this week. At 10 years and $11 billion, even giant EHRs went phalanxed with other giant government contractors to face DOD: Epic with IBM; Cerner with Leidos, Accenture and Intermountain Healthcare; Allscripts with Computer Sciences Corp. and Hewlett Packard. Certainly there will be ‘gravitational pull’ that affects healthcare organizations, but the open and unanswered question is if that pull will include the far nearer and immediately critical lack of interoperability with the Veterans Health Administration’s (VA) VistA EHR. The Magic 8 Ball reads: Hazy, try again later. Leidos/Cerner announced as winners close of business Wednesday 29 July.
In other EHR news, US doctors vented last week on how much they hate the @#$%^&* things to the American Medical Association‘s ‘town hall’ in Atlanta. Bloat, diminished effectiveness, error, getting in the way of care due to design by those without medical background presently prevail. The AMA’s Break the Red Tape campaign asks CMS to “postpone” finalizing Stage 3 Meaningful Use (MU) rules so that it can align with new payment/delivery models. Better yet, they should buy thousands of copies of Dr Robert Wachter’s book [TTA 16 Apr] and drop them on every policymaker’s desk there, with a thud. Health Data Management