In this issue:
Healthcare is not only a contentious antitrust issue, but a highly confusing one; we focus here on clinical integration. Christi Braun looks at the challenge of promoting cost-effective health care while controlling joint contracting; Heather Cooper gives some cautionary advice to physicians looking to join forces; Ashley Fischer & David Marx, Jr. analyze antitrust interaction with the new ObamaCare ACO’s; Melinda Hatton brings an insider’s viewpoint; Greg Pelnar analyzes the similarity between physician networks and cartels; and Greg Vistnes advises potential ACOs how to stay safe.
We’ve also added a timely bonus article—Antonio Bavasso & Simon Pritchard discuss how to use the U.K.’s spending review to implement some needed reform in U.K. competition policy; in particular, consolidating the current two-tier system of initial review and full investigation under a single roof.
Clinical Integration & Antitrust
The antitrust agencies are unlikely to challenge a clinical integration network that is able to generate significant efficiencies that benefit consumers and about which payers do not complain. Christi Braun, Ober Kaler
Federal Courts and Enforcers Diagnose Physician Practice Associations with Risk of Conspiracy Liability: Degree of Integration is Crucial to Challenges to Medical Network Price Agreements
Thanks to a recent federal district court decision, physicians and medical staff have more reason to think twice about price and other arrangements adopted by the practice associations and clinics to which they belong. Heather Cooper, Sheppard Mullin
Antitrust Implications of Clinically-Integrated Managed Care Contracting Networks and Accountable Care Organizations
This article explores how the DOJ and FTC have treated clinically-integrated managed care contracting networks under the antitrust laws, and how the Agencies are likely to apply those concepts to ACOs. Ashley Fischer & David Marx, Jr., McDermott Will & Emery
During the year-long debate over health care reform, removing barriers to clinical integration received far less attention than it should have. Melinda Hatton, American Hospital Assoc.
Are â€œclinically integratedâ€ physician networks that jointly contract with third-party payors such as Blue Cross little more than â€œcandy-coatedâ€ cartels? Gregory Pelnar, Compass Lexecon
The Interplay Between Competition and Clinical Integration: Why the Antitrust Agencies Care About Medical Care Delivery Styles
This discussion should help prospective ACOs understand how to pursue the benefits envisioned by the Affordable Care Act while avoiding antitrust concerns. Gregory Vistnes, CRA
Of Special Interest
There is, however, scope for reform to help the system, as a whole, deliver more for less. Antonio Bavasso & Simon Pritchard, Allen & Overy