One of the nation’s largest nursing home companies has recently become a “‘provider-sponsored organization,’ or a provider group that accepts full financial risk for its consumers[‘]” care in exchange for a fixed monthly payment. 42 In sum, consolidation of major players in the health industry constitutes an important force to be reckoned with, and the LTSS sector is centrally involved.
II. GENERAL POTENTIAL EXPECTIONS OF CONSOLIDATION
This section sets out, in very barebones fashion, 43 the most salient general potential expectations of consolidation in the healthcare industry. Consolidation may produce either positive or negative effects, and the specifics of both types are exceedingly difficult to predict accurately. 44 Section III applies these general potential expectations, both positive and negative, to specific groups of LTSS consumers, laying the groundwork for proposed research agenda elements. 45
A. Negative Potential Impacts
Consolidation in anyindustry ordinarily generates expectations of reduced competition in the marketplace of goods and services available for consumers. 46 A reduced number of competitors vying for the business of
the Payor Role, STRATEGY& (2015), http://www.strategyand.pwc.com/media/file/Healthcare- providers-take-on-the-payor-role.pdf (describing the concept of integrated delivery networks “as a model for a fully integrated system that employed the doctors and owned the hospitals and the insurer”). 42. Emily Mongan, Nursing Home Giant Signature Healthcare Pushes into Insurance Industry, MCKNIGHT’S LONG TERM CARE NEWS (Aug. 18, 2015), http://www.mcknights.com /news/nursing-home-giant-signature-healthcare-pushes-into-insurance- industry/article/433418. 43. Obviously, the present discussion neither aspires nor pretends to substitute for a comprehensive economics text. For a concise summary of basic concepts in economics, see generally TODD G. BUCHHOLZ, FROM HERE TO ECONOMY: A SHORTCUT TO ECONOMIC LITERACY (1995). 44. “[Consolidation’s] precise impact on the evolution of the health care ecosystem will be anything but straightforward.” Kaplan et al., supra note 38. Regarding the uncertain implications of hospital consolidation specifically, see Tim Xu et al., The Potential Hazards of Hospital Consolidation: Implications for Quality, Access, and Price, 314 JAMA 1337, 1337-38 (2015). 45. Regarding a research agenda, see generally H. Stephen Kaye & Charlene Harrington, Long-Term Services and Supports in the Community: Toward a Research Agenda, 8 DISABILITY & HEALTH J. 3 (2015). 46. See generally Graeme K. Deans et al., The Consolidation Curve, HARV. BUS. REV. (Dec. 2002), https://hbr.org/2002/12/the-consolidation-curve (discussing the industry consolidation life cycle, including decreased competition during stage 3).