Health Plan Weekly

In AIS Health’s annual roundup of health insurer executive compensation data, four newly public startup insurers stand out because their CEOs’ total compensation in 2021 easily outstrips that of chief executives at major firms like UnitedHealth Group and Cigna Corp. However, experts tell AIS Health that the startups’ filings with federal regulators paint an unintentionally deceiving picture, as the CEOs of those not-yet-profitable firms are highly unlikely to collect hundreds of millions of dollars’ worth of stock awards listed there. 

“They’re never going to realize, in one year, that much compensation,” says Ari Gottlieb, a principal at A2 Strategy Group who has been closely tracking the performance of the four startup insurers that went public in 2021: Alignment Healthcare, Inc., Bright Health Group, Inc., Clover Health Investments Corp. and Oscar Health, Inc.  

During the first three quarters of this year, private equity companies were involved in 725 health care services deals in the U.S. and Canada, according to a PitchBook report released on Nov. 15. That is more than the number of transactions that occurred during each of the years between 2017 and 2020 and on par with 2021 when a record 1,004 such transactions took place for the full year.  

PitchBook, a data analytics and software company, defined the health care services segment as “traditional health care providers that offer medical treatment in hospitals, clinics, residential facilities and homes.” UnitedHealthcare sponsored the report, but the insurer did not have editorial control.  

The rise in consolidation among hospital systems operating in different geographic areas may be hampering the competitive strength of health insurers by limiting their negotiating muscle, a new study in Health Affairs says. 

The pricing effects of hospital consolidation is not new. Previous research, including a 2020 report from the Medicare Payment Advisory Commission (MedPAC), shows that merging hospital systems tend to lead to higher prices. 

However, the new study seeks to unravel the effects of a particular phenomenon — what happens after a merger or acquisition (M&A) among hospitals that operate in different markets and the impact on downstream factors, including contract negotiations with insurers. 

When UnitedHealth Group completed its acquisition of Change Healthcare, Inc. in early October — a move made shortly after a federal judge dismissed an antitrust complaint against the deal — it seemed as though the companies could finally close the book on their nearly two-year quest to combine. However, last month the U.S. Dept. of Justice (DOJ) and officials from two states then filed a notice of appeal, once again casting uncertainty around the $13 billion deal.  

“The fact that, after losing their challenge at the district court level, the DOJ and the states waited until after the deal closed to file their appeal is somewhat unusual,” says Jim Burns, chair of the Williams Mullen Antitrust & Trade Regulation Practice Group. Usually, when regulators lose their case at the district court level, they file an immediate appeal and request that the court bar the parties from closing their transaction while that appeal is heard, he tells AIS Health, a division of MMIT.