Let’s Make a Deal — Insurer-Provider Bargaining and Evolving Antitrust Analysis of Provider Mergers

John Yi spoke on “Let’s Make a Deal — Insurer-Provider Bargaining and Evolving Antitrust Analysis of Provider Mergers” at the ABA’s 20th Annual Washington Health Law Summit.

In health care markets, prices are negotiated not between providers and patients, but between health care systems and insurers. Commercial health insurers negotiate with providers to build viable networks at prices employers will accept. As health care systems become more complex, so too do these negotiations. Continuing consolidation and evolving models of provider-insurer bargaining could affect the analysis of horizontal and vertical health care mergers in ways with which the courts have not yet grappled.

John — along with Stanford University professor of health policy Laurence Baker and Cornerstone Research vice president Dina Older Aguilar — discussed recent trends and signaled direction for health care merger enforcement, the effect of provider-insurer negotiations on relevant provider markets (including “crossmarket” mergers) and theories of harm that may arise from vertical mergers.