Why health care consolidation is a bad idea for RI

Teddy Roosevelt, former president and proud trust buster, had it right: monopolies are inherently bad.

Monopolies lead to decreased competition and choice and increased prices, and are therefore bad for society.

Unfortunately, monopolies, mergers and consolidation have become a big issue in health care. The latest, most flagrant example of this is the Change Healthcare debacle. Let’s just say that Change Healthcare has changed health care — but not in a good way.

In case you haven’t been paying attention, some background: In 2022, UnitedHealthcare, with the goal of expanding its reach, bought out a company called Change Healthcare in a $13-billion deal over the objections of the U.S. Department of Justice. The department rightly objected for antitrust concerns but ultimately lost the court case, and the buyout was allowed to proceed.

Fast-forward to 2024: On Feb. 21, Change Healthcare’s operations ground to a halt after falling prey to a cybersecurity attack. Because Change Healthcare handles things like reimbursing doctors and processing prior authorizations for patient medications, all these services have been paralyzed, leaving some physicians with little to no revenue and patients unable to get essential medications.

But here is where it gets worse. It turns out that Change Healthcare does not just handle operations for UnitedHealthcare. Other insurers use Change’s platform as well, which has only widened the scope of the problem. To give a sense of the extent of the issue, Change Healthcare manages one in three patient records, which translates into approximately 15 billion transactions per year.

As a result, some practices have been forced to shut down temporarily, as there is not enough money coming in to meet expenses. And some patients have been forced to go without much needed medications.

Astonishingly, given these extreme circumstances, the response from United and the government has been sluggish and insufficient, though there has been some progress in recent days.

Regardless of the outcome, the Change Healthcare debacle should be a wake-up call to anyone not already convinced that health care consolidation is a bad idea. We need more competition in health care, not less.

Right here in Rhode Island, there is room for improvement. Some groups have already been taken over by private equity, which should have never been allowed to enter the health care market in the first place given that they look at physician practices as nothing more than assets to pump and dump. Quality of patient care does not even enter into their thinking because they have no medical expertise.

And Rhode Island primary care practices are increasingly being bought out by hospitals due to poor reimbursements and narrow profit margins that make maintaining independence challenging. This is happening everywhere, but Rhode Island has been particularly hard-hit since our state routinely wins the dubious distinction of having the worst physician reimbursements in the country. Paying Rhode Island doctors on par with our neighbors in Massachusetts and Connecticut might go a long way towards attracting more physicians to our state and allowing more primary care practices to remain independent.

Why couldn’t Rhode Island become a shining example for other states to turn to when it comes to health care?

Here is a playbook for our legislators: First, oppose health care consolidation and mergers. Second, vote for pay parity for Rhode Island physicians on par with our neighbors. Third, oppose administrative burdens for physician practices such as prior authorizations, which take time away from patient care and create barriers for patients to get medications and services.

It’s a long shot, but I’m hoping that someone is listening.

Alexandra Tien is a family physician.

The Change Healthcare debacle should be a wake-up call to anyone not already convinced that health care consolidation is a bad idea. We need more competition in health care, not less.