Family Physicians predicts that consolidation, especially among health insurers, may create “mass disruptions in continuity of care due to changing and narrowing networks of” providers. 63 Narrow provider networks may be problematic for consumers for a large number of reasons. 64
B. Positive Potential Impacts
By contrast, it is arguable that increased coordination among LTSS providers and insurers may result in greater systemic efficiency; 65 according to this view, it “will make possible the elimination of considerable administrative costs, as new combinations render current systems and operations redundant.” 66 Enhanced operational efficiency should, in theory, lead to lower prices67 and better coordination and continuity of care, the lack of which has been described as what “may very well be the missing link of the healthcare delivery chain” 68 and which often is a very serious problem for contemporary LTSS consumers. 69 Operational efficiencies that ultimately will benefit consumers, as well as employers who subsidize health insurance for those consumers, are enthusiastically predicted by health providers and insurers participating in consolidation activities in their arguments against vigorous government antitrust scrutiny. 70 There are a few factors that might even support the claim that consolidation in the LTSS industry actually will contribute to an enhanced
63. Blackwelder 1, supra note 48; see also Blackwelder 2, supra note 48. 64. See generally Valarie Blake, Narrow Networks, the Very Sick, and the Patient Protection and Affordable Care Act: Recalling the Purpose of Health Insurance and Reform, 16 MINN. J.L. SCI. & TECH. 63 (2015) (key concerns being higher out-of-pocket expenses for consumers and reduced patient access to tertiary care). 65. See generally Roger D. Blair & D. Daniel Sokol, Quality-Enhancing Merger Efficiencies, 100 IOWA L. REV. 1969 (2015). 66. Kaplan, supra note 38. 67. Id. Lower prices should result from insurers’ stronger bargaining power to negotiate lower payment rates with providers and insurers’ increased ability to positively impact clinical management. However, “health insurance mergers also may contribute to increased hospital consolidation. . . due to hospitals seeking greater leverage in negotiating with a dwindling number of health plans.” James Swann, Insurance Industry Consolidation Could Mean Higher Premiums, BLOOMBERG BNA (Aug. 5, 2015), http://www.bna.com/insurance- industry-consolidation-n17179934363/. 68. Barbara Johansson & Jane Harkey, Care Coordination in Long-Term Home- and Community-Based Care, 32 HOME HEALTHCARE NURSE 470, 473 (2014). 69. See generally Richard Browdie, Why Is Care Coordination So Difficult to Implement?, 37 J. AM. SOC’Y ON AGING 62 (2013); AHIMA Staff, Lack of Acute, Long-Term Care Continuity Harming Patients, J. AHIMA (June 25, 2014), http://journal.ahima.org /2014/06/25/lack-of-acute-long-term-care-continuity-harming-patients. 70. Abelson, supra note 37. For an argument in favor of vigorous antitrust scrutiny as the best means to assure a competitive marketplace, see Thomas Greaney, Examining Implications of Health Insurance Mergers, HEALTH AFF. BLOG (July 16, 2015), http://healthaffairs.org/ blog/2015/07/16/examining-implications-of-health-insurance-mergers/.