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Health Plans Don't Always Play Hardball with Providers



Evidence suggests that some hospitals without must-have market power can get reasonably decent rates when health insurers are trying to maintain hospital competition in the market, a study shows.



2 comments on "Health Plans Don't Always Play Hardball with Providers"
Margaret Dick Tocknel (5/11/2012 at 10:01 AM)

Thank you for your comment. Please note that I am not advocating that approach but rather reporting its existence as identified in the study, which reports on multiple occurrences based on interviews in a dozen metropolitan areas. Although there is a DOJ suit pending in Michigan and Indiana has a state law that bans favored nation clauses, the study notes that provider negotiations are very nuanced and some insurers are able to simply outbid competitors.
Maria Todd MHA PhD (5/9/2012 at 1:09 PM)

RE: "Sometimes health plans don't play hardball when it comes to provider negotiations. They'll agree to large increases in provider payments as long as their competitors pay even higher rates." I seem to remember that this tact was frowned upon on as an antitrust issue - especially in most favored nations arguments in Pennsylvania and elsewhere, as causing even smaller insurers to pay more, rendering them unable to compete in the market place and therefore creating a detriment to the market. Why would you suggest such an option in a positive positive light as a viable strategy?