Beth Israel Deaconess-Lahey merger may be price-cap model

Beth Israel Deaconess Medical Center and Lahey Health officially combined to form Beth Israel Lahey Health, the second-largest health system in Massachusetts, the organizations announced Friday.

In November, Massachusetts’ attorney general approved the deal with conditions including a seven-year price cap; participation in MassHealth, the state’s combined Medicaid and Children’s Health Insurance Program; and $71.6 million in investments supporting healthcare services for low-income and underserved communities in Massachusetts.

The price cap guarantees Beth Israel Lahey Health’s price increases will remain below the state’s annual healthcare cost growth benchmark of 3.1% for seven years. That will prevent more than $1 billion of the potential cost increases over a seven-year span projected by the Massachusetts Health Policy Commission, according to Attorney General Maura Healey.

Healey’s assurance of discontinuance does offer some flexibility amid “significant change in market conditions,” including significant swings in the consumer price index or new laws that significantly raise the cost of care.

The Massachusetts Health Policy Commission, which has produced critical reports of the merger citing a potential to increase healthcare costs by up to $251 million per year, said it commends the conditions the attorney general placed on the deal that would help mitigate its concerns. They will have a real impact on access to treatment for mental health and substance-use disorders for patients across eastern Massachusetts, the commission said.

These types of regulations could become the new normal for hospital merger and pricing policy in the U.S., policy experts said.

Between the Massachusetts Health Policy Commission and strong attorney general, Massachusetts has been fairly far out in front in terms of healthcare policy, said Zack Cooper, associate professor of health policy and economics at Yale University.

“What they are signaling with this settlement is that they will allow these sort of entities, conditional upon enforcing price regulation,” he said. “This is the de facto price and spending cap may become the norm in the next decade or so. Frankly, we face a choice of using a public option to put pressure on providers and insurers or simply regulate directly.”

The industry is moving toward these types of monopolies that require price regulation, Cooper said. The challenge will be whether to regulate prices over the entire systems or only the overlapping sites. With the latter, the evidence shows that systems tend to shift the price increases to other sites in the system, he said.

“Capping prices for the entire system is a notable outcome of this ruling,” Cooper said.

The merger includes Beth Israel in Boston and Lahey in Burlington, as well as Boston’s New England Baptist Hospital, Mount Auburn Hospital in Cambridge and Anna Jaques Hospital in Newburyport.

Beth Israel Lahey Health operates a total of 10 hospitals as well as three affiliate hospitals in Cambridge Health Alliance, Lawrence General Hospital and Metrowest Medical Center.

Its network includes four academic and teaching hospitals with affiliations with Harvard Medical School and Tufts University School of Medicine, eight community hospitals, specialty hospitals for orthopedics and behavioral health, and ambulatory and urgent care centers. It has a population health enterprise and a centralized network of administrative and operational services, executives said.

“Through local and system partnerships, as well as the enthusiasm and talent of all our employees and providers, we will invest in and strengthen community-based care, informed by innovation and discovery,” Dr. Kevin Tabb, president and CEO of Beth Israel Lahey Health, said in prepared remarks.

The combined entity would have around $6 billion of revenue, more than 4,000 physicians and 35,000 employees.

Beth Israel and Lahey executives argued that their combination is necessary to heal a dysfunctional Massachusetts healthcare market that continues to overuse hospitals and academic medical centers. It’s the only way to check Partners, they said. Executives said they plan to expand the state’s now-limited behavioral health service network, helping divert patients from costly emergency departments. They pledged to use their combined purchasing power and expertise to lower costs, which they say will outpace any potential price increases.

Lahey Health narrowed its operating loss in 2018, but its expenses related to salaries and wages and supplies continued to rise. It reported a $29.6 million operating loss on revenue of $2.15 billion in 2018, compared to a $65.6 million operating loss on $2.03 billion in revenue in 2017.

CareGroup, which is the corporate parent of Beth Israel Deaconess, New England Baptist Hospital and Mount Auburn Hospital, reported $38.7 million of operating income on revenue of $3.53 billion in 2018, a significant increase from a $3.1 million operating loss on $3.33 billion of revenue in 2017.

https://www.modernhealthcare.com/mergers-acquisitions/beth-israel-deaconess-and-lahey-health-complete-merger