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With a variety of subscriptions to choose from, you can enjoy the print edition along with access to all tablet and smartphone apps, the e-Newspaper edition and a 30-day article archive. Subscribe today. 1.877.424.0208 Fremont News-Messenger Port Clinton News Herald Bucyrus Telegraph-Forum Marion Star Mansield News Journal Newark Advocate Coshocton Tribune Zanesville Times Recorder Lancaster Eagle Gazette Chillicothe Gazette The health care fever for consolidation has shot up, with two ma- jor deals closing out 2017, but the big question is whether consumers should be feeling any better this year. DaVita Medical Group, which has nearly 300 medical clinics along with about 40 surgery centers and urgent care clinics, will become part of United- Health outpatient clinic divi- sion. CVS own pharmacy management business and in-store clinics would be merged with Aetna.

PBMs negotiate deals with drug makers that include rebates and other compen- sation to encourage use of certain drugs and come up with lists of drugs their in- surance plans will cover. The deals will move the industry closer to a model in which doctors and insurers are part of the same company, in a Permanente-esque says Craig Garthwaite, who leads the health enterprise management program at Northwestern Kellogg School of Management. Under that scenario, there would be no incentive for health care providers to perform more tests and procedures than necessary on people. Instead, they would be pushed to make sure patients get the right care from the start and to keep them healthy. Since it became law under President Barack Obama, the Care concept of health care reform fo- cused on for better health rather than the utilization of health care ser- Garthwaite says.

Susan Hayes, founder of Pharmacy Outcomes Specialists, which audits PBM contracts for employers and unions, says the recent deals are just the of many, and worried about the mergers of insurance compa- nies, chain pharmacies and (health care) providers means less transparen- cy and higher costs bottom she says. PBMs are billed as a way to lower drug costs for employers and consum- ers, but increasingly come un- der in recent years as drug prices have soared. slice of the costs and role as a middleman are little understood. Critics of PBMs say the companies sometimes agree to favor high-cost drugs on the lists of medicines your in- surer agrees to pay for and that they agree they place quantity limits or prior authorization programs on the drugs. despite the fact doing so could help health plans save money and make medical sense.

How these deals could affect you You might get healthier. The com- panies will have a strong incentive to make and keep you well. Right now, Minute Clinics have that in- centive, as the more you show up there, the more money they make. Currently, Aetna and the employers whose plans it administers already have a strong motive to keep patients healthy. But without employing the doctors or own- ing the hospitals, they truly control how many tests, prescriptions or visits you get.

When the insurer and the health care provider are one and the same, more likely to things that encourage health to be covered. Linda Fish, who is the caregiver for her husband and brother near Albu- querque, New Mexico, is excited by the prospects of a CVS-Aetna deal. She has gotten good service at CVS and likes that she can get a shot and vitamins there. She was also impressed the company took a stand against My- huge price boost on EpiPens about a year ago when it began a low- cost generic version of an EpiPen com- petitor. a strong supporter of wellness she says.

husband, Richard, is a retired professional chef, and they the right foods prepared the right she says, meaning have to cook things in lard and The couple also have free membership to gyms in Albuquerque, thanks to their Humana Medicare Managed Care plan, so they work out as much as possible. Still, Fish hopes she and her family can switch to Medicare plan if the deal goes through. Dave deBronkart, a cancer survivor and patient safety advocate who blogs as e-Patient Dave, says he is favor of any evolution that makes it easier for people with health problems to get the care they But whether that will happen, he acknowledges, is to at the time of a merger. Your care could come under one roof. Davita best known for its dialy- sis centers could help launch United- Health into the movement away from high-priced hospital care.

Emergency room visits are the costliest form of health care for insurers, in large part be- cause of the higher costs involved in running a hospital and the fact that, un- der law, ERs have to at least stabilize all the patients who show up. With more of these clinics, and expanded versions of clinics, these insurers will have a place to send patients where they can control most types of care. Within a few years, clinics in or outside stores, in- cluding CVS, could consolidate vision and dental care, as well as primary and specialty care. You might save money or not. If insurers save money on healthier pa- tients, far from clear whether they will pass it along as lower premiums, Garthwaite says.

Even if they do, more competition will be needed among big companies such as CVS-Aetna for pre- miums to truly come down. If there is a worry there, he says that this kind of consolidation means it will be that much harder for new entrants to enter, so prices may not come down. Your insurer may still be able to game the system. Insurers have to spend a certain percentage of their pre- mium dollars on claims and other ex- penses that improve the quality of the health care you receive. But Garthwaite says they still ways to get around that, and it will be even easier if they own the health providers who treat you.

If UnitedHealth is setting the price at the Davita clinics, there will be far less incentive to make them lower than there would be if they were truly negotiating. You may not have as much choice. Teresa Stickler, an Arizona pharmacy owner, founded Pharmacists Unity for Truth and Transparency because of what she calls by PBMs, such as steering consumers to drugs with higher list prices. Now these insurance companies will be able to steer you to the doctors and drugstores they want you to go to, or at least make it even costlier to go elsewhere, Stickler says. You may not know ing.

Drugmakers have gotten the brunt of the criticism over soaring drug prices, but the pharmaceutical industry has successfully turned some of that nega- tive attention to PBMs due to their lack of transparency. These companies make their money on rebates and or fees charged in ad- dition to maintenance fees that boost drug prices. And doing quite well at it if buying insurance compa- nies, as in the case of Caremark. think it is apparent that PBMs are generating so much money through re- bates and spread pricing that they are now looking for ways to control the en- tire Hayes says. Hayes predicts that in the near we will see a health care compa- ny that includes a drug manufacturer, wholesaler, retail drug chain, insurers, doctors and clinics.

there will be no negotiation possible at she says. Health care deals could make you healthier but may not save you money Mergers could mean less transparency, higher costs Jayne USA TODAY Craig Garthwaite, who leads the health enterprise management program at Northwestern Kellogg School of Management, says insurers have found ways to get around requirements that they spend money to improve health care, and it will be even easier if they own the health providers who treat you. NORTHWESTERN UNIVERSITY.