Sam Melamed’s Post

Key factors driving ASC joint ventures and consolidation with health systems include cost efficiency, market diversification, patient preference, physician alignment, and value-based care models. ASCs offer high-quality care at lower costs, diversify services, meet patient preferences, provide ownership opportunities to physicians, and enhance efficiency through value-based care. ASC joint ventures positively impact patient outcomes by offering cost-effective, specialized care in comfortable environments with quicker turnover times. The collaborative nature aligns incentives to prioritize patient care, enhancing satisfaction and overall outcomes. The impact of the 2024 elections on healthcare consolidation and antitrust laws is a topic of interest. Understanding potential effects on partnerships, regulations, and market dynamics will be crucial for stakeholders navigating the evolving healthcare landscape in the future. **Disclaimer:** The views expressed in this post do not necessarily reflect the opinions or positions of any affiliated organizations or entities. This content is intended for informational purposes only and does not constitute an endorsement or criticism of any political party, candidate, or policy. Readers are encouraged to conduct their own research and form their own opinions. #Healthcare #ASC #JointVentures #PatientOutcomes #ValueBasedCare #2024Elections #Consolidation #AntitrustLaws

The healthcare industrial machine rolls on. After spending some time in payor land, I figured the below would be a crazy visual to put together. How have the 6 big publicly traded healthcare behemoths fared since 2010, on a pure revenue basis? Since 2010, these 6 vertically integrated players combined (note: including non-premium revenues) have seen their revenues increase 12.1% compounded annually, from $307.8B in 2010 to $1,356.3B in 2023. Transactions to call out include CVS’ purchase of Aetna, Cigna’s purchase of Express Scripts, and UnitedHealth Group aligning with 90,000 physicians while employing 10,000 of those – spending $30B+ in the last 2 years alone on acquisitions. Don’t be fooled – there is still plenty of room for these players to grow as the U.S. population ages. There are plenty of implications about healthcare baked into these numbers. P.S. if you like visuals like these join my newsletter along with 32k+ others here: https://lnkd.in/gniNmHvz

Revenue growth in the healthcare sector is significant, with a compound annual growth rate of 12.1% from 2010 to 2023 among six major healthcare companies. This growth is driven by acquisitions and an aging U.S. population, indicating a strong and expanding sector.

Think About It: "Pure Revenue" for publicly traded #healthplans and #payors: "From $307.B in 2010 to $1,356.3B in 2023." On the opposite end of this spectrum are the insureds, members and #physicians having to scratch and claw for their #medical and #healthcare needs and/or recommendations to be approved and bills to be paid, as well as, insureds/members worrying about if their #pii and #phi #data will be exposed on the #darkweb. #insurance #business #management #unitedstatessentate #ceo #coo #cfo #unitedstatescongress #hr #employeebenefits #healthcaresystems #cms #medicalcare #doctors #healthcareservices #cybersecurity #healthplan #patient #employers #healthcareexecutives #privatehealthinsurance #humanresources #hms #medicare #medicaid #hospitals #nurses #health #mergersandacquisitions #managedcare #medicine #wallstreet #pharma #privateequity #hipaa

The biggest Health System is missing, do you know who it is? It’s the EASIEST to sell into as well! Blake Madden's Hospitalogy analysis is phenomenal but missing the healthcare network with a $121B spending budget, the Department of Veterans Affairs (aka the VA) More impressive than its nearly $20B lead over Kaiser Permanente's $100.8B is the sales (and profit margin) advantage the VA offers. One of the primary reasons the VA is not considered in most healthcare conversations is because the VA doesn't generate revenue...it has a budget. While every group on this list must balance operating costs against profit margins…the VA doesn’t have that problem. Despite the rumors, or bad advice that seems to never die, the VA does not (because it can not) get the best pricing in healthcare. Anyone who has ever tried to sell into the "regular" networks on this list knows the incredible power of getting “on contract”. To get on-contract with these health systems, med device companies must sacrifice profits for market share, in the hope that volume will make up for the lost margins. These networks deal in “Hopium”. Instead of price eroding hopium, consider growing your market share at the VA. The VA can’t: 1️⃣ negotiate pricing based on market share commitments like civilian networks, 2️⃣ use contract status as the primary reason to approve or decline the use of a product! Instead the VA can: 1️⃣ increase pricing year over year 2️⃣ buy “off contract”! The VA has a bigger budget, and fewer purchasing limitations than any other healthcare network. Companies that don’t need to maintain or grow profit margins should avoid it, but for everyone else the VA should be a top priority! P.S. VA's requested budget for FY2025 is $152B…what’s your share going to be of this ever growing pie?

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Great article from the GH team on the complexities of value-based arrangements in the payer-provider landscape. I appreciate thinking about strategy from a LOB standpoint, and the market analysis that needs to occur to improve an entity’s chances for success in the varied models. Bravo

As reported by NBC News, STAT, and others, the House Committee on Oversight and Accountability held a hearing to investigate evidence of pharmacy benefit managers (PBMs) conducting anticompetitive practices driving up consumer healthcare costs. This is on the heels of an interim report from the Federal Trade Commission’s (FTC) investigation of PBM business practices, which was also prompted by complaints of anticompetitive behavior. Meanwhile, several bills have been introduced aiming to regulate PBMs.   The three largest PBMs control about 80% of the market, and are vertically integrated with health insurers, pharmacies, and providers. While vertical integration can benefit consumers, it can also create opportunities to profit at the expense of patients and plan sponsors, and foreclose competition from rivals.    Our publication with ATI Advisory evaluates proposed legislative reforms to regulate PBM practices while improving market competition and lowering healthcare costs. West Health proudly supports commonsense legislation on PBMs, especially those that improve competition and address the high and rising cost of healthcare in America.    • See our publication here: https://lnkd.in/eGGhiGKr • Read our letter to the FTC: https://lnkd.in/eFyU68DK • NBC News: https://lnkd.in/ghRss7R8 • STAT: https://lnkd.in/egA5F-_8 • FierceHealthcare: https://lnkd.in/eng9Mkjp • CNBC: https://lnkd.in/gjGwjeZv   #pricetransparency #PBMreform #healthcaretransparency #policyreform #prescriptiondrugaffordability #access #healthcareconsolidation

UnitedHealth Group analysis: ◦ Current List Price: $489.00 ◦ Price Change: +1.00 USD (+0.20%) - Positive uptrend ◦ Average daily volume: 3,138,391 shares - High liquidity and investor interest in this title ◦ Last 52 Week Price Range: $445.68 - $554.70 - Steady performance with potential for modest upside ◦ UnitedHealth Group stock is currently trading at $489.00 with a positive gain of $1.00 (+0.20%). With an average daily trading volume of 3,138,391 shares and a 52-week price range between $445.68 and $554.70, it can be concluded that the stock is showing stable performance with potential for further growth. Recommendation: Continue to monitor price developments and remain cautious of possible market volatility. An innovation for UnitedHealth Group Incorporated could be the introduction of an online platform for patients that would allow them to quickly and conveniently manage their health information, schedule medical appointments, communicate with healthcare providers, and receive relevant health information and tips. This platform could be easily integrated with existing Optum and UnitedHealthcare systems and bring benefits to both patients and the company in the form of improved care, more efficient communication, and higher customer satisfaction. This innovation could be relatively easily implemented and deliver immediate results. Josef Anger, the CEO, Owner, and Board Member of #CNBC #UnitedHealthGroup #Inovation #Healthcareinnovation #Onlinehealthplatform #Patientcare #Medicaltechnology #Healthcaretechnology #Digitalhealthcare #Healthcaremanagement #Healthinformation #Healthtips #Efficiencyinhealthcare  

Tidbits from UnitedHealth's quarterly earnings filing: * We expect to continue to incur direct response costs and experience business disruption impacts over the remainder of the year, including costs to continue to restore Change Healthcare’s services and the impact of suspended care management activities. *  For the three months ended March 31, 2024, we incurred $593 million of direct response costs, including network restoration and increased medical care expenditures, as we suspended some care management activities to help care providers with their workflow processes. Optum Insight also experienced estimated business disruption impacts of $279 million for the three months ended March 31, 2024, reflecting lost revenue... * In the first quarter 2024, as a result of the Change Healthcare cyberattack, we incurred $340 million of medical costs related to the temporary suspension of some care management activities, impacting our UnitedHealthcare and Optum Health businesses, to help care providers with their workflow processes.... https://lnkd.in/eBuA2YSH