Experts have been predicting consolidation in the healthcare industry for years, but it's never really happened on the scale the soothsayers anticipated. But now, they may finally be right. I know, it's a little like the boy who cried "wolf" to say that it's different this time, but I believe it, for a variety of reasons. Two announcements that came blowing out of Kentucky last month have convinced me it's for real this time.
Maybe you missed the early signs of a wave of consolidation in healthcare, brought about in large part because of the healthcare reform legislation that passed earlier in the year. I know I missed it initially. During all the craziness surrounding the November elections, it was easy to get distracted.
In this case, it happened in Kentucky, in two separate moves that basically divide the state into two large regional health systems, each with an academic side. Some would take issue with that characterization, but here are the particulars:
- Lexington-based UK HealthCare and Norton Healthcare, the Commonwealth's largest health system, have announced their intent to formalize a longstanding working relationship through an "alliance" to bolstering teaching and clinical programs.
- The nonprofit companies that operate three of Kentucky's largest hospital networks—Saint Joseph Health Systems, University of Louisville Hospital, and Jewish Hospital—intend to merge under an agreement approved by U of L trustees in November. They hope to complete the merger within a year.
Apparently, the state's hospital systems aren't waiting for new guidelines from the Federal Trade Commission to partner up in combinations that certainly would have raised antennas at the agency in the recent past. The Patient Protection and Affordable Care Act apparently has changed everything.
The Jewish-Louisville-St. Joseph merger brings together systems that control 42% of the market share in Louisville and 21.8% of the of the market share in Lexington, according to a story in the Lexington Herald-Leader. Not only does such a potential combination hold a powerful negotiating stance with state payers, but more importantly, it sends a message that system-ness, going forward, also means market share within a state or region within that state (they've only signed letters of intent to this point).
How do I come to that conclusion? Well, St. Joseph and its two locations in Lexington are currently part of Catholic Health Initiatives, a multi-state, Denver-based system that includes 73 hospitals. So they're not doing the merger primarily to gain access to capital or talent, one of many reasons hospitals have joined with larger systems in the past.
It's a market share play for Louisville to acquire Jewish, which lost money in 2009, and St. Joseph. CHI will add $300 million to the merged systems on top of contributing the assets of the two St. Joseph hospitals in Lexington, which shows why Louisville would be willing to take on those hospitals as well. When complete, the Herald-Leader says, the combined system will be within the geographic reach of two thirds of Kentuckians.
On the other side, and happening almost simultaneously, is the clinical "merger" between Louisville's Norton and UK Healthcare, based in Lexington. Though it's not a financial merger, at least not yet, the two systems will work together clinically to develop a "statewide system of care."
These events are touted as ways to improve healthcare in the state, but why now? Of course, the kicker is that now there's a financial incentive as well. Effectively, the federal government has forced these actions, for better or for worse. It's why the FTC has announced it's reforming the guidelines by which they will evaluate mergers.
The new law has forced collaborations that will provide high quality care while emphasizing efficiency and limiting duplication of services, and the FTC has gotten the message that it's to back off. These moves signal that the dance floor is apparently open, the band is tuning up, and organizations are finding dance partners…quickly.
Philip Betbeze is the senior leadership editor at HealthLeaders.