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NE W S & I N S I G HTS O N H E A LT H C ARE REFORM
Health Insurer Consolidation:
What Does the New “Big Three”
Mean for the Rest of Us?
CONTACT »
July 6, 2015
Paul Keckley
Last week, we learned Aetna reached an agreement to buy Humana in a $37 billion deal and
Managing Director
Anthem insisted its spurned offer to acquire Cigna is still on the table in a deal valued at $54 billion.
Navigant Center for Healthcare
Research and Policy Analysis
paul.keckley@navigant.com
615.351.0265
The rationale for these is clear: The commercial insurance market is shrinking and thinning
operating margins in the core business of selling group plans to employers. The new growth
market – Medicaid and Medicare – is not as profitable, so bigger scale is necessary to maintain
services and fund growth into new markets and new businesses. It’s that simple. In the
insurance industry, at least for the next few years, the “Big Three” will be United, Anthem and
Aetna, if these deals close as expected (See Fact File).
The fact is, the consolidation of these plans will not result in a “too big to fail” scenario in most
To receive future
markets. They will trail Blue Cross plans in many markets, especially in the southeast, and they’ll
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face regulatory scrutiny in places where their combined strength threatens competition. But the
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consequences in the system are no less significant.
For hospitals, the stakes are high. The tension between hospitals and plans is palpable in many
markets, but simultaneously plans are courting hospitals to partner in risk sharing relationships
like bundled payments and accountable care organizations. And some hospitals are starting their
own plans to compete with private insurers reasoning it’s the only way to be paid to manage
health. The Big Three bring powerful analytic tools capable of mining claims, utilization and clinical
data. Each has access to capital, capabilities in population health and care coordination, plan
design and marketing prowess in contracting with employers, individuals, and government. The
relationship between plans and hospitals is a testy relationship already. Consolidation of the Big
Three will prompt hospital boards to revisit their collaborate-or-compete strategies.
For physicians, it means more of their income and clinical autonomy will be subject to the
coverage and denial policies and procedures of the Big Three that already use powerful analytic
About Navigant Center for
Healthcare Research and Policy Analysis
Navigant Center for Healthcare Research and Policy
Analysis is Navigant Healthcare’s research center
that focuses on trends and issues relevant to each of
the industry’s major sectors. The Center’s role is to
monitor signals from the market, identify innovative
solutions and facilitate implementation in this fastchanging environment. The Center, headquartered in
Washington, D.C., is led by Paul Keckley, a healthcare
industry analyst, policy expert and Managing Director
at Navigant.
tools in their analyses. Reputation and individual physician preference will take backstage
to data about adherence to evidence, inappropriate variation, outcomes, efficiency, patient
experiences and more, and narrow panels will replace open networks. Shared risk arrangements
and physician profiling are a critical focus of the Big Three. For physicians, contract negotiations
with the “Big Three” will be more aggressive and access to clinical and financial data about the
performance of the practice table stakes.
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For employers, the issue is cost. That’s it. As chronicled on page
The Big Three automakers lost ground to imports. The Big Three
one of Saturday’s New York Times, rate increases for 2016 are
television networks lost viewership to cable. The Big Eight
likely to be higher than any seen in recent years. Large self-insured
accounting firms are now four. And the Big Four U.S. airlines found
employers will dodge the bullet somewhat, but smaller and mid-
out last week they’ll be in court for price gouging while fuel costs
size companies and individuals will take the biggest hit. The “Big
went down and fares went up.
Three” will challenge employers to consider innovative ways to
reduce costs and improve quality. They will promote high deductible
plans, carve outs, reference pricing and hyper-narrow networks as
employers brace for the Cadillac tax and employer mandate ahead.
For employers, head-to-head competition among the Big Three
and the Blue Cross plans is seen as a positive IF lower cost is the
Being big is no guarantee of success. Change is a constant in the
U.S. health insurance market. For every stakeholder in the U.S.
system, the new Big Three and evolving role of the Blue Cross
plans is only another chapter in the book “Financing Healthcare” in
which its final chapter is yet to be written.
result. They’ll watch closely. They’re paying attention.
Paul
For drug companies, it’s certain to strengthen the hand of the “Big
PS: Special thanks to Marina Karp and Jing-yuan Qian for
Three” in purchasing expensive drugs at a steeper discount, or in
their assistance in compiling and analyzing the insurance data
their placement in a more restrictive formulary wherein cheaper
summarized in today’s Fact File.
drugs with at/near equivalent efficacy are used first. The Big Three
Sources: Bob Herman, “Risky Business: More Health Systems
are keen to lower drug costs: that’s job one. Specialty pharma
costs are a vexing issue among plans. At $84,000 for a course of
treatment, Solvaldi works well for hepatitis C patients, and Gilead
booked more than $10 billion from its sale last year. But health
insurers face pushback when trying to pass these costs through
in premiums. With costly new drugs for cancer, super-statins and
others on the market soon, the Big Three will amplify calls for
stricter access and lower pricing for drugs.
Launch Insurance Plans despite Caveats,” Modern Healthcare,
April 6, 2015; “Provider-Owned Plans Fare Well in Wake of
Affordable Care Act,” AM Best Financial Review, February 26,
2015; Jeff Goldsmith, Lawton P. Burns, “Integrated Delivery
Networks: Is the Whole Less than the Sum of the Parts” Modern
Healthcare, March 9, 2015; Melanie Evans, “Hospital Health
Plans tighten Tension with Insurers,” Modern Healthcare, March
23, 2015; Robert Pear, “Health Insurance Companies Seek Big
For state and federal policymakers, the advent of the Big Three
Rate Increases for 2016,” New York Times, July 3, 2015; Moody’s:
will spark refreshed urgency to answer questions about expanded
Healthcare Quarterly looks at developments in US healthcare in
coverage and the future of the insurance system itself. In the
2015 Moody’s Investor Service - Global Credit Research, January,
Affordable Care Act, an initial set of reforms was initiated. Access
2015; Melanie Evans, “Despite Rate Complaints, Advantage
to coverage via Medicaid expansion and insurance marketplaces
Plans continue to Grow,” Modern Healthcare, April 13, 2015;
(a.k.a. exchanges) increased, but issues remain in how our country
“Deals” Anthem, Cigna Talking as Centene Makes Deal Cigna also
goes about financing the care we use. And, the government
continues to pursue possible takeover of Humana, Wall Street
can play a strong hand in determining the direction and tone
Journal, July 2, 2015; Philip Bump, “Barack Obama: The health-care
of the discussion. Between Medicare and Medicaid alone, the
industry president,” Washington Post, July 2, 2015
government insures more than 124 million. The government
will watch the Big Three carefully while long-term reform in the
insurance system enters a new phase. The balance of regulatory
oversight between states and the federal government, the potential
for a new “pre-Medicare” plan, purchasing coverage across state
lines and other issues will be front and center in D.C. and every
state legislature. Re-visiting regulation of the insurance industry’s
future is a risky proposition for lawmakers but unavoidable.
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I N D USTRY PULS E
Tuomey settles FCA case for $237 million. Sumter, S.C.-based
Tuomey Healthcare System must pay the $237 million judgment
previously entered against it in a False Claims Act case after a
three-judge panel of the U.S. Fourth Circuit Court of Appeals
unanimously upheld the district court’s ruling last Thursday.
The sum is believed to be the largest ever levied against a
community hospital and exceeds the hospital’s annual revenue.
Lisa Schencker, “$237 million Tuomey judgment upheld by federal
appeals court,” Modern Healthcare, July 2, 2015
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Visits to private primary care physicians by women with
Medicaid were less likely to include recommended preventive
services. A new study conducted by researchers at the Urban
Institute found that doctors order fewer preventive services and
procedures for Medicaid patients. The services examined were
clinical breast exams, pelvic exams, mammograms, Pap tests and
depression screening. An estimated 26.4% of visits by women
with Medicaid included at least one of the recommended services,
compared to 31.3% of visits by privately-insured women. Visits
by women with Medicaid were also less likely to include a clinical
breast exam, a pelvic exam, a Pap test, and a mammogram,
Can the state compel a self-funded insurer to turn over its
compared to visits by privately insured women. Stacey McMorrow,
data? The Supreme Court has agreed to hear Gobeille v. Liberty
Sharon K. Long and Ariel Fogel, “Primary Care Providers Ordered
Mutual, a case with significant implications for the states’ authority
Fewer Preventive Services For Women With Medicaid Than For
over the healthcare sector. The issue in the case is whether
Women With Private Coverage,” Health Affairs, June 30, 2015.
Vermont can force health insurers—including employers that self-
[Health Aff June 2015 vol. 34 no. 6 1001-1009]
insure—to tell state officials the prices they pay for medical care.
Vermont wants to put that information in an “all-payer claims
database” to enable regulators and consumers to get a picture
of how the healthcare market operates in the state. At least 15
other states have laws creating similar databases. Nicholas Bagley,
“Can Vermont ask its employers about health-care prices?,” The
Incidental Economist, June 29, 2015
Tight ties between docs and pharma and device industries. The
second batch of data is in on providers’ financial ties to industry:
Doctors and teaching hospitals received $6.5 billion last year from
drug companies and medical device firms for research, consulting
and other reasons. The public can access data on 607,000 U.S.
physicians and 1,121 teaching hospitals through the government’s
Open Payments database. There were 1,444 companies that made
Age a factor associated with safety and requirement of
payments in 2014. About half of the $6.5 billion in payouts were
vaccines. Findings from a new Pew Research Center poll on
classified for research purposes. More than $2.5 billion was labeled
a broad set of science-related topics indicates that Americans’
as general payments, and $703 million represented ownership
political leanings are a strong factor in their views about issues
or investment interests held by medical providers. Chad Terhune,
such as climate change and energy policy, but much less of
“Doctors, hospitals get $6.5 billion from drug, medical device firms
a factor when it comes to issues such as food safety, space
last year,” Los Angeles Times, July 1, 2015
travel and biomedicine. Another area where party and ideology
have minimal influence includes the way adults think about
vaccines. Especially notable is how beliefs, including vaccine
refusal, combined with decisions by some parents to spread out
vaccines over longer periods of time than recommended, may
be contributing to low vaccine coverage rates among schoolaged children. Younger adults are less inclined than older adults
to believe vaccines should be required for all children: 37% of
adults under age 50 say parents should be able to decide not to
vaccinate their children, compared with 22% of those ages 50 and
Teladoc shares soared during the company’s IPO. Teleconferencing
between doctors and patients has the possibility to save consumers
around $104 billion a year and the potential to make companies that
provide the service a lot of money. Exemplifying this trend includes
Teladoc, a healthcare service connecting patients to one of 700
board-certified doctors over the phone. The company saw its shares
jump up 50% as shares were priced at $19 to open and by day’s end
priced at $29.50. Bob Bryan, “You can now invest in the movement to
revolutionize doctor visits,” Business Insider, July 3, 2015
older. By contrast, in 2009, opinions about vaccines were roughly
the same across age groups. Pew Research Center, July 1, 2015,
“Americans, Politics and Science Issues.”
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Deals
Proposed Policy Changes
Aetna acquiring Humana: Friday, Aetna announced it will buy
»»
Modifying the Two-Midnight Rule (see below)
Humana in a $37 billion cash and stock deal making it the nation’s
»»
Clarify the scope of services in the chronic care management
second-largest insurer behind United. Louisville-based Humana
has nearly 3.2 million people enrolled in Medicare Advantage
payment codes
»»
plans, a total that falls just short of market leader UnitedHealth
Group. “The combined Aetna-Humana would have 2015
revenues of roughly $115 billion, with just more than half of that
income coming from government programs. The country’s largest
insurance company, UnitedHealth, has projected revenue of $143
billion for this year.” “Insurer Aetna agrees to buy competitor
Reduces the number of Ambulatory Payment Classifications to
account for changes in medical practices and technologies
»»
Adds nine new Comprehensive Ambulatory Payment Classifications
»»
Conditionally packages some ancillary services and drugs
»»
Will accept public comment on preliminary device passthrough applications
Humana in deal valued at $37B,” Washington Post Business By
»»
Removes certain codes from the ASC covered ancillary services list
Associated Press, July 3, 2015
»»
Adjust the Hospital Outpatient Quality Reporting (HOQR)
Program, including adding two measures, removing one, changing
Medicaid insurer Centene Corp. to acquire fellow insurance
provider Health Net Inc.: The announcement marks the third
major insurance company merger in less than a week. Centene
the deadline to withdraw, and changing submission timeframes
»»
Center Quality Reporting (ASCQ) Program measures
Corporation (NYSE: CNC) and Health Net, Inc. (NYSE: HNT)
announced that the Boards of Directors of both companies
have unanimously approved a definitive agreement under which
Centene will acquire all of the shares of Health Net in a cash and
Requests feedback on two potential Ambulatory Surgical
Proposed Two-Midnight Rule Modifications
»»
Stays Expected Less Than Two Midnights
››
stock transaction valued at approximately $6.8 billion, including
of the admitting physician. The documentation in the
the assumption of approximately $500 million of debt. The
medical record must support that an inpatient admission is
acquisition would create a “leading platform for government-
necessary, and is subject to medical review.”
sponsored programs and one of the largest Medicaid Managed
››
Care Organizations in the country.”“Centene To Combine With
CMS will prioritize these cases for medical review.
PRNewswire, July 2, 2015
2016 Medicare hospital outpatient proposed rule released.
Last Wednesday, CMS released the calendar year 2016 Hospital
Outpatient Prospective Payment System (OPPS) and Ambulatory
Surgical Center (ASC) Payment System proposed rule, which
updates Medicare payment policies and rates for 3,800 hospital
outpatient departments (HOPDs), 5,300 ASCs, and partial hospital
services provided by 60 community mental health centers (CMHCs).
Proposed Payment Changes
»»
OPPS rate adjustment is -0.2% (accounting for policy changes)
»»
ASC rate adjustment is 1.1%(multifactor productivity-adjusted
CPI-U update)
»»
Laboratory services conversion factor is decreased -2.0%
Inpatient hospital admissions for a minor surgical
procedure or other treatment are “rare and unusual” so
Health Net In Transaction Valued At Approximately $6.8 Billion,”
G OV ER NME NT PULS E
Inpatient status is permissible “based on the judgment
»»
Stays Expected Over Two Midnights
››
»»
No change
Enforcement
››
Quality Improvement Organizations (QIOs) will conduct
the first line medical reviews of inpatient claims
››
Recovery Audit Contractors will focus on only those
hospitals with consistently high denial rates
Comments are due August 31, 2015, and the final rule will be
issued on or around November 1, 2015.
Centers for Medicare and Medicaid Services, “CMS Proposes
Hospital Outpatient and Ambulatory Surgical Center Policy and
Payment Changes, Including Proposed Changes to the TwoMidnight Rule, and Quality Reporting Changes for 2016,” July 1,
2015; CMS, “Fact Sheet: Two-Midnight Rule,” July 1, 2015
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2014 Reinsurance Payments and Risk Adjustment Results
California enacts strict child vaccine law. Governor Jerry Brown
announced. CMS released the first year results for two of the ACA’s
signed into law a new child inoculation requirement, one of the
premium stabilization programs, Reinsurance and Risk Adjustment.
country’s strictest because it bars religious and personal-belief
The Reinsurance program collected $8.7 billion in fees from 484
exemption. The law applies to all public school children beginning
carriers offering qualified health plans in the individual market and
with the 2016 school year and has a medical exemption. Rich
will distribute $7.9 billion to 437 carriers for claims cost greater than
Pedroncelli, “California Gov. Jerry Brown signs new vaccination
$45,000 but less than $250,000. (Note CMS recently increased
law, one of nation’s toughest,” LA Times, July 2, 2015
the reinsurance level from 80% of the claims cost to 100%). The
$800 million balance will be used for the Reinsurance program in
2015 and 2016. 758 insurers participated in the Risk Adjustment
program, which reallocates funds from lower risk plans to higher
risk plans within a State’s individual and small group market. It will
transfer 10% in the individual market, 6% in small group, 21% in
catastrophic, and 2% in states with merged markets. Timothy Jost,
“Implementing Health Reform: First-Year Results From Reinsurance
And Risk Adjustment Programs,” Health Affairs, July1, 2015.
21 Century Cures Bill update. The House released an updated
st
21st Century Cures bill, which is designed to expedite biomedical
research and drug approval. The policy remains nearly identical
to the version approved by the House Energy and Commerce
Committee, but the NIH funding increase of $10 billion was
decreased to $8.75 billion. The financial offset has changed too:
the proposed timing change to Medicare Part D reinsurance
payments was removed and the amount of petroleum to be
sold from the Strategic Petroleum Reserve was increased. Brett
Norman, “Final Cures bill includes smaller NIH funding boost,”
PoliticoPro, July 2, 2015
OIG to increase healthcare false claims enforcement. The OIG
unveiled a new team of ten lawyers to litigate healthcare cases
under “Civil monetary penalties law, the False Claims Act, the antikickback statute and the OIG’s authority to exclude providers from
federal health programs”. The team will enforce cases against all
types of providers, and will prioritize doctor-hospital compensation
arrangements. Lisa Schencker, “OIG beefs up legal team to bust
more healthcare fraudsters,” Modern Healthcare, July 1, 2015
County level Healthcare.gov data released. HHS released
county level Qualified Health Plan selection data for Healthcare.gov
enrollees from the 2015 Open Enrollment Season (November 15,
2014 through February 15, 2015). The data covers over 8.8 million
plan selections on the 27 Federally-Facilitated Marketplaces, seven
Partnership Marketplaces, and three Federally-Supported Statebased Marketplaces, and is broken out by receipt of Advanced
Premium Tax Credit. “Plan Selections by County in the Health
Insurance Marketplace,” July 3, 2015.
Supreme Court temporarily allows ten Texas abortion clinics
to remain open. The U.S. Supreme Court issued a stay of
enforcement on a lower court’s ruling allowing ten Texas abortion
clinics to remain open while lawyers petition the Supreme Court
to hear their case. At issue is a 2013 law requiring abortion clinics
to meet outpatient surgery center standards and for doctors who
perform abortions to have admitting privileges at a nearby hospital.
It is uncertain if the Court will take the case during its next term.
Carrie Fiebel, “Supreme Court Reprieve Lets 10 Texas Abortion
Clinics Stay Open For Now,” NPR, June 30, 2015
Supreme Court issued stay in religious challenge to birth
control coverage accommodation. The U.S. Supreme Court
issued a stay of enforcement on the requirement that non-profit
religious institutions issue a written request for an exemption from
contraceptive coverage requirements. It is uncertain if the Court
will take the case during its next term. Robert Pear, “Court Lets
Some Charities Avoid Rules on Birth Control Coverage,” New York
Times, June 29, 2015
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FACT F IL E: H EA LTH INS UR A N C E
Plan Consolidation: 2015
COMPANY
PREMIUMS
2014 Bil $$$
COMMERCIAL
Enrollment (Mil)
(Market Share)
MEDICARE
Enrollment (Mil)
(Market Share)
MEDICAID
Enrollment (Mil)
(Market Share)
MARKET
CAPITALIZATION1
United HG2
$115,302
28.750
(16.9%)
8.170
(15.2%)3
5.055
(8.0%)
115.95 Billion4
Anthem5
$68,389.8
29.364
(17.3%)
1.404
2.6%
5.193
(8.0%)
43.16 Bil
Cigna6
$27,214
2.534
(1.5%)
0.459
(0.85%)
0.059
(0.09%)
41.51 Bil
Aetna7
$49,562.2
19.822
(11.7%)
1.140
(2.1%)8
2.124
(3.4%)
43.83 Bil
Humana9
$45,959
2.384
(1.4%)
6.390
(12.9%)10
0.299
(0.47%)
28.08 Bil
Centene11
$14,198
0.332
(0.2%)12
0.393
(0.73%)
2.755
(4.4%)
8.85 Bil
Health Net13
$13,361.1
1.192
(0.7%)
0.275
(0.51%)
1.676
(2.7%)
5.52 Bil
Anthem - Cigna
Aetna - Humana
Centene - Health Net
Sources/Notes:
1. All market capitalization data extracted on July 4, 2015. It might vary due to stock price change.
2. United States Securities and Exchange Commission, Form 10-K, “Anthem Inc.”, Feb 24, 2015.
3. Include Medicare Advantage and Medicare Part D, not include Medicare Supplement.
4. All market capitalization data is from Yahoo Finance, https://biz.yahoo.com/ retrieved online at 7/4/2015.
5. United States Securities and Exchange Commission, Form 10-K, “Anthem Inc.”, Feb 24, 2015.
6. United States Securities and Exchange Commission, Form 10-K, “Cigna.”, Dec. 31, 2014.
7. United States Securities and Exchange Commission, Form 10-K, “Aetna Group.”
8. Include Medicare Advantage and Medicare Part D, not include Medicare Supplement.
9. United States Securities and Exchange Commission, Form 10-K, “Humana Inc.”, Feb 20, 2015.
10. The value is not reported in the Financial Statement, but is manually calculated by adding different sectors together.
11. United States Securities and Exchange Commission, Form 10-K, “Centene.”, Dec. 31, 2014.
12. Centene’s financial statement does not have a specific line item for “commercial health insurance”. This value includes marketplace health insurance, long term insurance and behavioral health insurance. It does not include public-private
“hybrid” insurance.
13. United States Securities and Exchange Commission, Form 10-K, “Health Net.”
14. The most reliable source of total health plan premiums is published by National Association of Insurance Commissioners.
15. Kaiser Family Foundation. “Graphics and Interactives”. http://kff.org/graphics/search/ Retrieved online on 7/4/2015.
16. Centers for Medicare and Medicaid Services. “CMS Fast Facts”. March 2015 Version. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Fast-Facts/. Retrieved online on 7/4/2015.
17. Centers for Medicare and Medicaid Services. “CMS Fast Facts”.
18. Yahoo Finance, “Industry Sector: Health Plans”. https://biz.yahoo.com/p/5conameu.html Retrieved online on 7/4/2015
19. All data in this row are calculated as the total market size subtracted by all line items above.
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Provider-sponsored plans: 698 hospitals, representing approximately
Medicare out-of-pocket: OOP is increasing. Caps are $6700 for
90 sponsors, have an equity interest in an HMO in 2013, up from 11%
MA plans: the # between $5001 and $6700 increased from 25% in
in 2012 provider sponsored plans. Their average profit margin was
13 to 41% in 14. Traditional Medicare deductibles and co-pays will
3.2% in 2013 and has hovered at 3% since 2010. (AHA)
increase 6.8% in 2016. (Kaiser Family Foundation)
Health plan margins: The overall health insurance plan industry
Study: Integrated systems: “We reviewed more than 30 years
margin is down from 4.5% in 2010 to 3.2% in 2013. Premiums
of academic literature on vertical integration and diversification in
collected by provider-sponsored plans increased 5.5% in 2013
healthcare, and found virtually no measurable benefits—either to
vs. 2.4% for investor-owned, Blue Cross Blue Shield (2.5%) and
society or to the sponsoring healthcare enterprises themselves—
others (3.2%). Total enrollment is 19.1M in 2013—4% increase
of putting health insurance, hospitals and physician services
(+8.2% in Medicare and +15.3% Medicaid). (AM Best)
under the same structure….We also examined publicly available
Medicare Advantage rates: MA rates will increase 1.26% for 2016
vs -3.8% in 2015 and cuts every year since 2010. (CMS April, 2015)
performance information on 15 nationally prominent IDNs and
found no evidence of either lower cost or higher quality in the
hospital systems they operated….we found the IDNs’ flagship
Medicare Advantage enrollment: 8% annual growth rate since
hospitals…were more expensive than their direct in-market re
2010 to 17.3 Mil—one third of all on Medicare. 97% have vision/
competitors in cost per case and total cost of care. There was no
dental/hearing benefit, 90% do not pay a premium and the average
apparent relationship between how concentrated the local hospital
premium is $62.69 in 2015—2% higher than 2014. (Health Pocket)
market was and the IDN’s operating earnings. Further, the size of
the IDN (measured by total hospital bed count or total revenue)
did not correlate with profitability….Neither scale nor scope of
economies could be detected” Jeff Goldsmith, Lawton Burns,
“Commentary | Integrated delivery networks: Is the whole less
than sum of the parts?” Modern Healthcare, March 7, 2015
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Enrollment Changes Since 2005: CMS
TYPE
TOTAL ENROLLMENT 2015
ENROLLMENT CHANGE 2005-2015
Medicaid
69.7 mil
+52.2%
Medicare
54.4 mil
+31.1%
Individual
25.2 mil
+25.4%
Employer sponsored
172 mil
-3.5%
Workers in high deductible plans: 61% of workers in companies
have a $1000+ deductible vs.16% in 2006, 41% in 200+ firms (vs
10% in 2006) and 32% in 200 or less (versus 6% in 2006). The
average deductible in employer sponsored coverage is $1217 in
2014, a 7% increase in year (JAMA)-by 2019, providers could see a
50% increase in amount collected from patients with 30% written
off ($200B)—(Kaiser Family Foundation, Citi Retail Services)
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Navigant Consulting is not a certified public accounting firm and does not provide audit, attest, or public accounting services. See navigantconsulting.com/licensing for a complete listing of private investigator
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The opinions expressed in this article are those of the author and do not necessarily represent the views of Navigant Consulting, Inc. The information contained in this article is a summary and reflects current
impressions based on industry data and news available at the time of publication. Any predictions and expectations noted herein are inherently uncertain and actual results may differ materially from those
contained in this article. Navigant undertakes no obligation to update any of the information contained in the article.
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