Brendan Keeler’s Post

🚨 Breaking Healthcare Industry News: DOJ Challenges UnitedHealth's $3.3B Amedisys Acquisition Key Points: - DOJ and four states have filed suit to block UnitedHealth's acquisition of home health provider Amedisys - Critical concerns: The merger would give UHG control of 30%+ market share in 8 states - Following UHG's recent LHC Group acquisition, this move signals heightened regulatory scrutiny of healthcare consolidation Industry Implications: 📊 Market Impact: This challenge reflects growing concerns about healthcare consolidation and its effects on: - Patient choice and care quality - Healthcare workforce employment options - Market competition in home health services 💡 Broader Context: This case highlights the increasing regulatory focus on maintaining competition in healthcare delivery, especially as the home health sector becomes increasingly vital to our healthcare infrastructure. #HealthcarePolicy #HomeHealth #MergersAndAcquisitions #HealthcareBusiness #Competition #DOJ #Healthcare #IndustryNews https://lnkd.in/ggZCSN2H

Med-Metrix Acquires HRSI - Healthcare Receivable Specialists Inc. Learn more & get our take 👇 https://lnkd.in/gCKZcKhT “HRSI has earned an outstanding reputation as a leading Eligibility Management platform, leveraging decades of domain expertise. We are excited to partner with Chad Wallace and his leadership team to bring their capabilities to the healthcare market throughout the U.S.” — Joseph Davi, Founder and CEO at Med-Metrix “Reflecting on HRSI’s growth over the past few decades, we are immensely proud of the outcomes our team has delivered for our customers. We look forward to building on this momentum in partnership with Med-Metrix, particularly in the Medicaid Eligibility market.” — Linda Wallace, CEO and President, and Chad Wallace, Executive Vice President at HRSI “The acquisition of HRSI underscores and further accelerates Med-Metrix’s end-to-end focused RCM growth strategy. AMCP looks forward to supporting Med-Metrix’s high growth trajectory, including additional strategic M&A opportunities.” — Robert Haisch, Partner at Alvarez & Marsal Capital (AMCP) #acquisition #RCM #SoHCNews

I recently had the opportunity to share my thoughts with MedCity News on UnitedHealth Group’s (UHG) acquisition of Amedisys. The Federal Trade Commission and DOJ’s decision to require the divestiture of Amedisys to VitalCaring to address anti-trust concerns is a crucial step. However, the challenge we face goes far beyond this single merger. As I said in the interview: “I am deeply concerned about the growing control UHG exerts over the U.S. healthcare system,” Brown said in an email. “UHG already runs the largest private health insurer in the country and manages a substantial physician network. Their influence and market dominance make negotiating with them or competing against them extremely challenging. “The DOJ’s scrutiny of this particular merger is essential, but we should also consider the broader implications,” he continued. “UHG’s recent Change Healthcare hack highlighted industry-wide financial and patient care challenges. At what point will we recognize that UHG is becoming a ‘too big to fail’ behemoth that we continue to feed?” The issue at hand is the extensive #verticalintegration of UHG, which is reshaping the landscape of healthcare delivery and financing in the U.S. I urge my peers, regulators, and policymakers to examine the broader impacts of such consolidations on our healthcare system. We must ensure that competition remains fair and that patient care does not suffer due to monopolistic practices. Your thoughts and insights are welcome! #Healthcare #MergersAndAcquisitions #UnitedHealthcare #Amedisys #VerticalIntegration #HealthcarePolicy #PatientCare #MarketCompetition #HealthcareLeadership UNC Center for the Business of Health UNC Kenan-Flagler Business School MBA@UNC ESCP Business School ABIG Health Meroka

HouseWorks Acquires AccordCare’s Connecticut Personal Care Division - HIT Consultant #HouseWorks Acquisition: HouseWorks has acquired AccordCare's Connecticut Personal Care Division, expanding its reach in the home care industry. #Strategic Growth: The acquisition of AccordCare's division allows HouseWorks to strategically grow its presence in Connecticut and enhance its services for clients in the region. #Enhanced Services: HouseWorks aims to provide enhanced services to clients in Connecticut through the acquisition of AccordCare's Personal Care Division, ensuring high-quality care for individuals in need. #Impact on Healthcare IT: The acquisition of AccordCare's division by HouseWorks may have implications for healthcare IT systems and technology integration, as the two companies merge their operations. #Future Expansion: With this acquisition, HouseWorks is poised for future expansion and growth in the home care ai.mediformatica.com #acquisition #provider #medicaid #acce #market #model #digitalhealth #healthit #healthtech #healthcaretechnology @MediFormatica (https://buff.ly/3wKHBAV)

🔷Early in my career in healthcare, a more mature senior executive told me that you have to 'do the basics right' before you try the more complicated stuff. In the case of physician practice billing and hospital billing, the basics are things like: 🔷Accurate and compliant documentation 🔷Correct and substantiated coding 🔷Effective and efficient claims submission 🔷Tracking and monitoring your revenue cycle 🔷Speedy follow up on denied claims and re-submissions 🔷Appropriate and understandable bills and statements for patients. 😀✅I can still remember my days in Detroit, studying the coding manuals, documentation guidelines and so forth in order to slowly and methodically reduce claims denials, improve documentation and get to compliant coding/billing...all reducing the costs and improving process flow. Patients were happier because they were less often 'put in the middle' between doctor and insurance plan; doctors found the system easier to use and profitability went up. 🔷❓Was it fast solution? No way. Was it sustainable. You bet. 🔷Sadly, many healthcare systems simply don't do the basics well. Others want to turbo charge their documentation and coding in order to enhance revenue (a fancy term for bill more) and yet still others have major issues with compliance and efficiency in their revenue cycle. ...and so we outsource these services. 🔷✅When you can't do the basics, what would make you think you can do the more complicated stuff? 🔷😳➡️R1 RCM makes its money under the assumption that health system clients cannot (or do not/will not) get the basics of revenue cycle right and they willingly take on this task (for a fee of course). Driving up costs to the healthcare system and, in turn, increasing revenue charges to the patient/insurer. #healthcare #revenuecyclemanagement #privateequity

" A few key factors have contributed to financial challenges in the healthcare sector. High interest rates have impacted access to capital, while - in the US - new requirements from the Federal Trade Commission (FTC) and state anti-trust regulations may limit merger and acquisition possibilities. Additionally, labor and supply expenses continue to squeeze margins and payment rates from payers are generally not aligned with inflation. Gibbins Advisors predicts that smaller organizations with revenue under $500 million may face harsher challenges than larger health systems in 2024 as financial hurdles persist. Going forward, healthcare organizations can avoid future financial challenges, such as bankruptcy, by developing investment strategies, reviewing budgets and staffing models, and prioritizing revenue cycle management, the report concluded.

Insurtech company Alignment Health recently announced mixed results for 2023 and 2024 guidance. Results include: - Revenue: $1.82 billion for 2023, exceeding market expectations. Projected to reach $2.4 billion in 2024. - Earnings per share (EPS): Loss of 25 cents in 2023, missing analyst expectations. - Expects positive adjusted EBITDA in 2024. Membership: - Expects to reach 162,000-164,000 members in 2024. - Medical benefits ratio: 89.4% for 2023. ACO REACH program: - Company restructures involvement to reduce financial risk. Focuses resources on core #Medicare Advantage (MA) business. Learn more: https://hubs.ly/Q02mWt350

How much value is left in digitizing healthcare revenue cycle management? According to TowerBrook, its partners, and its Go Private acquisition of R1 RCM, the total indeed exceeds its nearly $9 billion acquisition cost. Waystar's first 60 days as a public company are promising, seeing 20% growth for Q2 YOY. Over the next 4-5 years, RCM's macro growth is anticipated to be in the $34 billion range. The problem being solved is HUGE, and all parties benefit. I'm still amazed at the level of human intervention I see in our enterprise clients seeking to manage their RCM independently. Dozens of seats filled with contact center agents were being handed manual to-do lists by their managers printed from their PM system. Phone calls, emails, etc...... It's hard to believe this still exists to have a bill paid. The effort and time to payment are ludicrous........ Enhanced technology from dedicated RCM providers and Practice Management systems investing in RCM solutions will continue to generate fierce competition, driving value creation for this critical piece of the provider business needs. With typically three parties to a two-party transaction in healthcare billing (provider, patient, insurance company), the administration continues to crush practices. R1 RCM's long-term contracts and acquisition strategy over the last few years are testaments to a well-played long-term strategy and clearly a driver in its acquisition value. Providers need to pay attention to these solutions and options; the ability to enhance the overall patient experience and their cash flow is dependent on this specialized industry. https://lnkd.in/eS9u--Wg https://lnkd.in/euNKvXG8

Healthcare mergers and acquisitions have been a clear target for antitrust review and concern. In recent weeks, the Federal Trade Commission and Department of Justice signaled they will give heightened scrutiny to healthcare deals involving private equity firms. Now, the Department of Justice, Federal Trade Commission, and U.S. Department of Health and Human Services (HHS) created a website for consumers to submit complaints about competition in the healthcare space. Generally, consumers can speak best with their dollars and business, even in a consolidated market, and oftentimes, consumers do not have the background on the "why" behind a merger or acquisition. With so many hospitals continuing to balance rising labor costs, inflation on basic goods, and reimbursement rates that are lagging behind, this blanket anti-consolidation sentiment may have unintended consequences, particularly for rural communities and hospitals affected most by these trends.

The 4/26 Healthcare Labyrinth Newsfeed is live. Click below to read. Major stories: -- FTC extends data privacy to digital apps -- Study shows hospital mergers raise price -- Positive Centene financial news -- Wegovy gets green light from some MA plans #healthcare #healthcarereform #healthinsurance #healthcarelabyrinth