This case study uses Colorado APCD data to examine a 2017 insurer-physician acquisition, finding that integration inflated Medicare Advantage diagnosis-based payments by $1,000–$1,800 per patient annually without corresponding treatment increases, while steering commercial patients toward cheaper specialists. The authors conclude that integration creates a cross-market tradeoff and that pay-per-patient contracts can replicate the coding effect, making merger-focused antitrust policy insufficient on its own.
Case Study Link: Aligning Incentives or Gaming the System? The Impact of Insurer-Physician Acquisitions
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