UnitedHealth Group (UHG), which owns the big insurer UnitedHealthcare (see above story) is attempting to purchase Change Healthcare, and MHA, in a letter to Attorney General Maura Healey
says the merger raises serious anticompetitive questions.
Under the plan, UHG would acquire Change Healthcare and consolidate it under its competitor, Optum, which is also owned by UHG. Change and Optum are technology companies that essentially control and process the data that insurance companies use to determine reimbursements, claims, revenue cycle decisions, and clinical decision support services.
“Because Optum’s parent, UHG, also owns the largest health insurance company in the United States – UnitedHealthcare – the combination of these data sets would affect (and likely distort) decisions about patient care, claims processing, and claims denials to the detriment of consumers, healthcare providers, and even other health plans,” MHA wrote Healey. “Eliminating an important rival would stifle competition and extend UHG’s already massive market power to other markets in the healthcare system and presents significant antitrust concerns.”
If Change Healthcare is insurer controlled through Optum/UHG, as opposed to existing independently, then, MHA told the AG, “Optum could exploit its significantly reinforced and expanded data and data analytics capabilities across a variety of products and services as a healthcare ‘clearinghouse’ to favor its UnitedHealthcare subsidiary. Optum also will have strong financial incentives to use competitive payers' data to inform its reimbursement rates and set its competitive clinical strategy, which will reduce competition among payers and harm hospitals and other providers. For example, Optum could share pricing information from competitor claims that pass through its clearinghouse to help inform UnitedHealthcare's negotiations with providers.”
The American Hospital Association has also objected to the merger, telling the U.S. Department of Justice
, “Change’s independence from payers and its function as an ‘honest broker’ is another critical element of competition. The loss of a key independent competitor that is similar in size to Optum in these essential services will likely result in higher prices for providers and in lower quality clinical outcomes for patients.”