Psoriasis Spotting and Scarring: How to Cope

25 Largest Health Systems By Physicians

Assessing a health system's size through its physician workforce can provide a more holistic view of its capacity and scope. 

This overview of the top U.S. Health systems by total physicians is information that can be taken in combination with measurements of large health systems by the number of hospitals they operate and the number of beds they include.  

As a reference point to the counts below, UnitedHealth Group's Optum announced in November that it had added nearly 20,000 physicians in 2023 for a total that now nears 90,000 employed or affiliated physicians. 

The 25 health systems' physician, hospital and bed counts stem from the Compendium of U.S. Health Systems for 2022, released in December 2023, from the Agency for Healthcare Research and Quality. Systems are ranked below by total physicians, with the additional data points of hospital and bed counts, to provide a more complete picture. 

The physician count in the compendium comes from IQVIA OneKey data, which is collected through surveys. The total is aggregated at the health system level and includes all physicians (medical doctors and doctors of osteopathy) regardless of specialty who had attending, staff or treating affiliations with facilities in the system. 

Kaiser Permanente (Oakland, Calif.)Physicians: 25,352Hospitals: 41Beds: 9,217

CommonSpirit Health (Chicago) Physicians: 15,019Hospitals: 147Beds: 17,107

HCA Healthcare (Nashville, Tenn.) Physicians: 14,232Hospitals: 184Beds: 37,478

University of California Health (Oakland) Physicians: 13,920Hospitals: 10Beds: 3,427

Providence (Renton, Wash.)Physicians: 13,203Hospitals: 54Beds: 9,511

Trinity Health (Livonia, Mich.)Physicians: 12,026Hospitals: 102Beds: 14,706

Northwell Health (New Hyde Park, N.Y.) Physicians: 12,000 (count self-reported to Becker's) Hospitals: 21Beds: 5,287

The University of Texas System (Austin) Physicians: 11,466Hospitals: 7Beds: 1,640

Ascension Health (St. Louis) Physicians: 10,724Hospitals: 119Beds: 16,103

Advocate Health (Charlotte, N.C.)Physicians: 10,307Hospitals: 58Beds: 10,528

Mass General Brigham (Boston)Physicians: 9,127Hospitals: 15Beds: 2,715

Mayo Clinic Health System (Rochester, Minn.) Physicians: 7,792Hospitals: 26Beds: 2,758

Sutter Health (Sacramento, Calif.)Physicians: 12,000Hospitals: 27Beds: 3,543

UPMC (Pittsburgh)Physicians: 6,896Hospitals: 34Beds: 6,047

New York Presbyterian Healthcare System (New York City)Physicians: 6,580Hospitals: 8Beds: 3,970

Tenet Healthcare (Dallas) Physicians: 6,514Hospitals: 74Beds: 12,690

Cleveland Clinic Physicians: 5,737Hospitals: 20Beds: 5,106

Mount Sinai Health System (New York City)Physicians: 5,393Hospitals: 5Beds: 2,452

Beth Israel Lahey Health (Cambridge, Mass.) Physicians: 5,343Hospitals: 10Beds: 2,101

Prospect Medical Holdings (Los Angeles) Physicians: 5,002Hospitals: 13Beds: 1,944

Johns Hopkins Health System (Baltimore)Physicians: 4,711Hospitals: 6Beds: 2,316

BJC Healthcare (St. Louis) Physicians: 4,470Hospitals: 16Beds: 3,166

University of Pennsylvania Health System (Philadelphia)Physicians: 4,198Hospitals: 9Beds: 2,915

Corewell Health (Grand Rapids, Mich.) Physicians: 4,198Hospitals: 24Beds: 4,689

UW Medicine (Seattle) Physicians: 4,197Hospitals: 4Beds: 1,229

A New Test Could Save Arthritis Patients Time, Money And Pain. But Will It Be Used?

SAN DIEGO — Erinn Maury knew Remicade wasn't the right drug for Patti Schulte, a rheumatoid arthritis patient the physician saw at her Millersville, Maryland, practice. Schulte's swollen, painful joints hadn't responded to Enbrel or Humira, two drugs in the same class.

But the insurer insisted, so Schulte went on Remicade. It didn't work either.

What's more, Schulte suffered a severe allergic reaction to the infusion therapy, requiring a heavy dose of prednisone, a steroid with grave side effects if used at high doses for too long.

After 18 months, her insurer finally approved Maury's drug of choice, Orencia. By then, Schulte's vertebrae, weakened by prednisone, had started cracking. She was only 60.

Schulte's story of pain, drug-hopping, and insurance meddling is all too common among patients with rheumatoid arthritis, who often cycle agonizingly through half a dozen drugs in search of one that provides a measure of relief. It's also a story of how doctors are steered by pharmacy benefit managers — the middlemen of the drug market — as well as by insurers.

Once people with inflammatory conditions such as rheumatoid arthritis reach a certain stage, the first prescription offered is typically Humira, the best-selling drug in history, and part of a class known as tumor necrosis factor inhibitors, or TNFis, which fail to significantly help about half of the patients who take it.

"We practice rheumatology without any help," said Vibeke Strand, a rheumatologist and adjunct clinical professor at Stanford. She bemoaned the lack of tools available to choose the right drug while bristling at corporate intervention in the decision. "We are told by the insurer what to prescribe to the patient. After they fail methotrexate, it's a TNF inhibitor, almost always Humira. And that's not OK."

If there's a shred of hope in this story, it's that a blood test, PrismRA, may herald an era of improved care for patients with rheumatoid arthritis and other autoimmune conditions. But first, it must be embraced by insurers.

PrismRA employs a predictive model that combines clinical factors, blood tests, and 19 gene patterns to identify the roughly 60% of patients who are very unlikely to respond to a TNFi drug.

Over the past 25 years, drug companies have introduced five new classes of autoimmune drugs. TNFis were the first to market, starting in the late 1990s.

Some 1.3 million Americans have rheumatoid arthritis, a disease in which a person's immune system attacks their joints, causing crippling pain and, if improperly treated, disfigurement. The newer drugs, mostly so-called biologics, are also used by some of the 25 million or more Americans with other autoimmune diseases, such as lupus, Crohn's disease, and psoriasis. Typically costing tens of thousands of dollars annually, the drugs are prescribed after a patient fails to respond to older, cheaper drugs like methotrexate.

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Until recently, rheumatologists have had few ways to predict which of the new drugs would work best on which patients. Often, "it's a coin flip whether I prescribe drug A or B," said Jeffrey Curtis, a rheumatology professor at the University of Alabama-Birmingham.

Yet about 90% of the patients who are given one of these advanced drugs start on a TNFi, although there's often no reason to think a TNFi will work better than another type.

Under these puzzling circumstances, it's often the insurer rather than the doctor who chooses the patient's drug. Insurers lean toward TNFis such as adalimumab, commonly sold as brand-name Humira, in part because they get large rebates from manufacturers for using them. Although the size of such payments is a trade secret, AbbVie is said to be offering rebates to insurers of up to 60% of Humira's price. That has enabled it to control 98.5% of the U.S. Adalimumab market, even though it has eight biosimilar competitors.

PrismRA's developer, Scipher Medicine, has provided more than 26,000 test results, rarely covered by insurance. But on Oct. 15, the Centers for Medicare & Medicaid began reimbursing for the test, and its use is expected to rise. At least two other companies are developing drug-matching tests for rheumatoid arthritis patients.

Although critics say PrismRA is not always useful, it is likely to be the first in a series of diagnostics anticipated over the next decade that could reduce the time that autoimmune disease patients suffer on the wrong drug.

Academics, small biotechs, and large pharmaceutical companies are investing in methods to distinguish the biological pathways involved in these diseases, and the best way to treat each one. This approach, called precision medicine, has existed for years in cancer medicine, in which it's routine to test the genetics of patients' tumors to determine the appropriate drug treatment.

"You wouldn't give Herceptin to a breast cancer patient without knowing whether her tumor was HER2-positive," said Costantino Pitzalis, a rheumatology professor at the William Harvey Research Institute in London. He was speaking before a well-attended session at an American College of Rheumatology conference in San Diego in November. "Why do we not use biopsies or seek molecular markers in rheumatoid arthritis?"

It's not only patients and doctors who have a stake in which drugs work best for a given person.

When Remicade failed and Schulte waited for the insurer to approve Orencia, she insisted on keeping her job as an accountant. But as her prednisone-related spinal problems worsened, Schulte was forced to retire, go on Medicaid, and seek disability, something she had always sworn to avoid.

Now taxpayers, rather than the insurer, are covering Schulte's medical bills, Maury noted.

Precision medicine hasn't seemed like a priority for large makers of autoimmune drugs, which presumably have some knowledge of which patients are most likely to benefit from their drugs, since they have tested and sold millions of doses over the years. By offering rebate incentives to insurers, companies like AbbVie, which makes Humira, can guarantee theirs are the drugs of choice with insurers.

"If you were AbbVie," Curtis said, "why would you ever want to publish data showing who's not going to do well on your drug, if, in the absence of the test, everyone will start with your drug first?"

What Testing Could Do

Medicare and commercial insurers haven't yet set a price for PrismRA, but it could save insurers thousands of dollars a year for each patient it helps, according to Krishna Patel, Scipher's associate director of medical affairs.

"If the test cost $750, I still only need it once, and it costs less than a month of whatever drug is not going to work very well for you," said Curtis, a co-author of some studies of the test. "The economics of a biomarker that's anything but worthless is pretty favorable because our biologics and targeted drugs are so expensive."

Patients are enthusiastic about the test because so many have had to take TNFis that didn't work. Many insurers require patients to try a second TNFi, and sometimes a third.

Jen Weaver, a patient advocate and mother of three, got little benefit from hydroxychloroquine, sulfasalazine, methotrexate, and Orencia, a non-TNFi biologic therapy, before finding some relief in another, Actemra. But she was taken off that drug when her white blood cells plunged, and the next three drugs she tried — all TNFis — caused allergic reactions, culminating with an outbreak of pus-filled sores. Another drug, Otezla, eventually seemed to help heal the sores, and she's been stable on it since in combination with methotrexate, Weaver said.

"What is needed is to substantially shorten this trial-and-error period for patients," said Shilpa Venkatachalam, herself a patient and the director of research operations at the Global Healthy Living Foundation. "There's a lot of anxiety and frustration, weeks in pain wondering whether a drug is going to work for you and what to do if it doesn't." A survey by her group found that 91% of patients worried their medications would stop working. And there is evidence that the longer it takes to resolve arthritis symptoms, the less chance they will ever stop.

How insurers will respond to the availability of tests isn't clear, partly because the arrival of new biosimilar drugs — essentially generic versions — are making TNFis cheaper for insurance plans. While Humira still dominates, AbbVie has increased rebates to insurers, in effect lowering its cost. Lower prices make the PrismRA test less appealing to insurers, since widespread use of the test could cut TNFi prescriptions by up to a third.

However, rheumatologist John Boone in Louisville, Kentucky, found to his surprise that insurers mostly accepted alternative prescriptions for 41 patients whom the test showed unlikely to respond to TNFis as part of a clinical trial. Boone receives consulting fees from Scipher.

Although the test didn't guarantee good outcomes, he said, the few patients given TNFis despite the test results almost all did poorly on that regimen.

Scientists from AbbVie, which makes several rheumatology drugs in addition to Humira, presented a study at the San Diego conference examining biomarkers that might show which patients would respond to Rinvoq, a new immune-suppressing drug in a class known as the JAK inhibitors. When asked about its use of precision medicine, AbbVie declined to comment.

Over two decades, Humira has been a blockbuster drug for AbbVie. The company sold more than $3.5 billion worth of Humira in the third quarter of 2023, 36% less than a year ago. Sales of Rinvoq, which AbbVie is marketing as a treatment for patients failed by Humira and its class, jumped 60% to $1.1 billion.

What Patients Want

Shannan O'Hara-Levi, a 38-year-old in Monroe, New York, has been on scores of drugs and supplements since being diagnosed with juvenile arthritis at age 3. She's been nauseated, fatigued, and short of breath and has suffered allergic reactions, but she says the worst part of it was finding a drug that worked and then losing access because of insurance. This happened shortly after she gave birth to a daughter in 2022, and then endured intense joint pain.

"If I could take a blood test that tells me not to waste months or years of my life — absolutely," she said. "If I could have started my current drug last fall and saved many months of not being able to engage with my baby on the floor — absolutely."

• • •

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.

2024: Healthcare Insiders Predict The Future

A group of industry experts opine on the future of healthcare.

Getty Images

A couple of weeks ago I offered my Top 10 Healthcare Industry Predictions For 2024 and already we're seeing some of what I wrote coming to pass.

Or are we?

I predicted that Cigna was seeking a union with another national player with a strong footprint in government programs. A few days later, Cigna and Humana signaled their intent to merge. And now it looks like the engagement may be off. We'll see. Whether or not this one goes through, I stand by my prediction that an era of big plan mega-mergers is in front of us.

Can others predict what the future holds for healthcare? To find out, I asked colleagues, friends and other people I admire in the healthcare industry to weigh in with their predictions for 2024. From AI to pharmaceuticals to the cost of care, their viewpoints cover a range of topics. I hope you find their predictions and insights as intriguing as I do.

Artificial Intelligence

Several experts predict artificial intelligence will lead change in the delivery of care. Some ... [+] disagree about how fast.

AFP via Getty Images AI to Bridge the Gaps to Human-Centered Health Care

Artificial intelligence (AI) and machine learning (ML) have the promise of bridging gaps in medical education and creating efficiencies for a more human-centered approach to health care. Alice L. Walton School of Medicine will prepare doctors of the future and enhance traditional medical education with the arts, humanities, and cutting-edge technology.

Knowing that AI-powered algorithms are already being used for diagnosing disease and recommending treatment options, we are exploring AI's role within student-faculty discussions and in course activities and labs; we also recognize the importance of building in methods for students to question AI-generated recommendations.

As a new medical school slated to open in 2025, pending accreditation, we are focused on training students with tools that augment the doctor-patient relationship. For example, we're looking at natural language processing for real-time dictation and reporting that can improve health equity and allow doctors more time with patients to address their physical, mental, emotional, and social needs—Sharmila Makhija, MD, MBA, Founding Dean & CEO, Alice L. Walton School of Medicine

The LLM-ification of Healthcare

Digital health startups will increasingly prioritize showcasing their integration of generative AI to demonstrate their value proposition. Investors will place greater importance on AI capabilities when considering funding opportunities, driving the need for startups to integrate these technologies even if completely unnecessary. This shift will also bring forth challenges for purchasers, who may struggle to assess the performance, cost-effectiveness, and auditability of these AI models. Buyers will be challenged to discern which companies have the necessary data and expertise to fine-tune AI models or effectively structure and map healthcare data. In 2024, navigating the complex world of healthcare AI will require a greater focus on transparency and education—John Brownstein, Ph.D, Professor, Harvard Medical School and Chief Innovation Officer, Boston Children's Hospital

Generative AI

2024 will be the year that Generative AI in healthcare will start to move from "pilot" only use cases into full production and there will be at least one major news event around bias / misuse in clinical delivery that forces the industry to examine the appropriate pace of clinical delivery use cases going forward. While most healthcare players are not trying to use Generative AI with true PHI data, this event will showcase that several players may in fact be using PHI data in actual production models. Our industry's early missteps on traditional rules-based AI models, such as Sepsis alerting in clinical workflows, have demonstrated that various actors across the healthcare ecosystem embed models into clinical decision workflows without broad knowledge or understanding. As a result of this, the growing Responsible AI movement from the government to industry players will substantially gain momentum in 2024 and may result in a slowing of uptake around Generative AI in healthcare for the next number of years—Keith Figlioli, Managing Partner, LRVHealth

The Hype Around AI Transforming Medicine Will Accelerate While Usage by Clinicians Will Be More Limited

Healthcare loves a new new thing and generative AI is now it. CHAT GPT 4 and other large learning and generative models are truly revolutionary, but change in clinical medical is always evolutionary. However, futurists, journalists, innovators and investors will dominate headlines and make it seem as if the revolution in medical care is already a done deal.

But it isn't, as far as most of clinical medicine goes. Close attention to the media barrage will reveal a lot of present participles and future tense qualifiers like "are looking into," and "are in process of." The administrative side of medicine will see traction but at the bedside, fears of GIGO - garbage in, garbage out - will prevail. Basing diagnoses on data gathered from the internet has all the biases of the past with respect to racism and other inequities and is population based vs. The patient on front of you. Plus, hallucinations - where large learning models make up stuff - will lead clinicians to conclude that AI at the bedside, e.G., making diagnoses and treatment recommendations, is interesting but not ready for prime time. Physicians rightly expect peer-reviewed studies and will look to the FDA for regulation.

On the other hand, the use AI in diagnostic areas like pathology and radiology will see substantial growth. Peer-reviewed, well-designed studies have shown that more cancers are found without increasing false negative results. Several tools in radiology and pathology have received FDA approval. The rate-limiting step here is payment, or the lack thereof. However, the results will be so compelling and consumer demand so high that we will see true take-off in these areas—Robert Galvin, Executive Advisor, Blackstone

Pharmaceuticals & Therapeutics

Pharmaceutical innovation is predicted to be part of the landscape in 2024.

SOPA Images/LightRocket via Getty Images Weight Health is the New Weight Loss

In 2023, GLP-1 medications (i.E. Wegovy) helped thousands of Americans lose weight quickly, which sharply increased demand for the high-cost drugs and put pressure on employers and payers to cover them. Now that GLP-1s have seemingly cracked the code on weight loss, how can patients keep the weight off while optimizing post-loss body composition, and is there any path for employers and payers to see ROI? While GLP-1s are intended for long-term use alongside consistent diet and exercise, millions will likely stop taking the drugs eventually due to cost, side effects, and personal preferences, leading many of them at high risk of regaining the weight. This phenomenon will turn the industry's focus from weight loss, i.E. The initial reduction of weight, to weight health, i.E. Keeping the weight off. Scientifically, preventing weight gain is a much more challenging and complex endeavor given the physiological processes at play. The TL;DR: after significant weight loss in a short period of time, the body does everything it can to pack the pounds back on. In 2024, we'll see the healthcare industry innovating on weight health solutions, specifically for patients who've chosen to discontinue GLP-1s—Sean Duffy, Co-Founder & CEO, Omada Health

Category Creation Will be the Expectation, Not the Exception

Traditionally, category creators have represented a modest percentage of new therapeutic launches. But the last year alone has seen a significant number of "firsts" across a wide range of therapeutic areas desperate for innovation, including rare disease, ophthalmology, neurology, obesity and others – an exciting development for the industry and for patients. And being first has its advantages. More than half of market innovators and pioneers met or exceeded launch expectations, compared to only a few of the companies who brought incremental innovation (or "me too" drugs) to the market.

Nevertheless, true category creation requires both a breakthrough product and a breakthrough business model. Those who invest in both sides of the equation will have more access to capital, experience faster growth with the potential for more stability and steady revenues, and generally enjoy greater brand longevity. Importantly, category creation also means you are putting patient needs at the center of your innovation engine.

So, rev up those engines! Category creation will be essential in 2024—Bobak Azamian, MD, PhD, CEO and Chairman, Tarsus Pharmaceuticals

Alzheimer's Imaging and Treatment Will Explode, Even as Impact on Outcomes is Small

Leqembi (lecanemab-irmb) is a monoclonal antibody approved by the FDA for the treatment of early Alzheimer's (mild cognitive impairment or mild dementia) disease. It is expensive, has occasional serious side-effects, including brain swelling and bleeding, and requires infusion in a qualified center. In addition, most patients will receive one or more imaging studies before and during their treatment. Many patients will be referred for PET imaging which may obviate treatment; still others will have PET imaging to diagnose and then measure response; others will have CT scans and MR scans to identify and manage complications. Genetic testing may also occur for individual patients and then their family members, as appropriate.

The drug itself may cost $20 – 25K per patient, but the associated imaging and testing costs could turn out to be equally high, particularly if there are excess screening exams for patients who do not qualify for the drug. There will be more drugs coming down the pipeline. The current effectiveness for Leqembi is relatively low.

While early estimates suggest that over 100K will qualify and use treatment, annually, this is not expected to occur immediately. But even with 20 – 30K patients in 2024, we will gain a lot of valuable real world experience with these drugs: their costs, their complications, their impacts on health equity, and, hopefully, their outcomes—Howard P. Forman, Professor of Radiology and Biomedical Imaging, Economics, Public Health, and Management, Yale University

Neurostimulation is the new Fitbit

While there has been lots of interest in new psychoactive medications and substances like legalized marijuana, ketamine, and mescaline, I think people will lose interest in these and flock to neurostimulation instead. A growing body of exciting clinical data show that neurostimulation works very well and is very safe. With more demand, there should emerge new, nicer, and easier to administer devices; some that are even stylish. I suspect many clinical and consumer use cases will gain traction and that we will see patients as well as students, workers, athletes, and stressed-out parents all finding neurostimulation helpful. This will lead to important ethical and regulatory questions about equity, long term effects in non-clinical people, and new workplace culture norms. I also think the data is super exciting for higher potency neurostimulation administered in hospitals for severe refractory depression—Bob Kocher, MD, Partner, Venrock

Community Health

Will every American eventually have a community health worker involved in their care?

getty Response to Workforce Challenges Will See a Rapid Expansion of the Role of Community Health Worker

The evolving landscape of healthcare, marked by the emergence of new payment models emphasizing the holistic care of patients, is driving the transformation of frontline health roles, particularly Community Health Workers (CHWs). As healthcare organizations increasingly adopt models that address both clinical and non-clinical aspects of patient and client needs, CHWs are poised to play a pivotal role in enhancing healthcare quality, facilitating care coordination, alleviating provider burdens, and fostering trust among patients and consumers. Projections indicate a substantial 14 percent growth in the employment of community health workers from 2022 to 2032, surpassing the average growth rate for all occupations. This shift reflects a strategic response to workforce challenges, underscoring the vital contribution of expanded roles within healthcare teams—Cheryl Pegus, Managing Director, Morgan Health Ventures

A New Focus on the Economic Fragility of Older Adults

There will be greater elevation of the economic vulnerability of soon-to-be Medicare eligible older adults (10K per day) as well as those who are 65 and over. Across the country, people are already noticing older adults who are becoming unsheltered all over for the first time in their lives. Those with sustained (and long-term) care and clinical needs have quickly emptied modest if any "rainy day" savings. As a result, emergency departments will become even more overloaded, wait times will increase, and family members who provide in-home support for those who are geographically distant will struggle to find sufficient care resources post hospitalization. Last but not least, these challenges will shine a light on the dearth of in home caregivers. Policy, programs and infrastructure will need reframing. It's not clear if that will happen—Jennie Chin Hansen, Former CEO, American Geriatrics Society

The Practice of Medicine

Doctors have long unionized in the UK. Could 2024 be the year that doctors more aggressively ... [+] unionize in the US?

© 2023 Bloomberg Finance LP The Medical Resident Union Movement Will Grow

Residents are the lynch pin in providing patient care across America, and they have too often been neglected by their institutions. As the country navigates financial crises, closure of safety net hospitals, and global pandemics, residents are standing in gaps which are becoming chasms in our health care infrastructure. Residents do not just serve their own patients; they prop up the American health care system, and they do so with hours, days, weeks of underpaid and underappreciated labor.

So, after many years of residents being overlooked and disregarded by health care systems, I offer this prediction: they have had enough. Residents, with their nursing colleagues, serve as the backbone of the health care delivered in academic medical centers. Their power and importance cannot be overstated. It should not have taken unionization for this to be recognized and valued. Residents deserve salaries and benefits which align with their many years of education, the value of the roles that they play, and the contribution that they make.

Over the course of the next year, many more residents across America will continue to organize and insist upon the respect of which they are so fully deserving—Holly J. Humphrey, MD, MACP, President, Josiah Macy Jr. Foundation

Clinical organizations will invest in the clinician experience.

The pandemic pushed clinician burnout to an all-time high and organizations are finally recognizing the need to prioritize the clinician experience in a meaningful way. In 2024, we can expect to see true changes to compensation structures, operational workflows, tooling (with AI technologies playing a key role), and new scopes of roles. The organizations that do this right will see an outsized impact on their ability to recruit and retain clinicians, while driving positive outcomes for patients. Organizations that continue the old playbook of "wellness days and stress balls" will visibly struggle—Nworah Ayogu, MD, MBA, General Manager, Amazon Clinic

Goodbye Marcus Welby

While the Biden administration promised to crack-down on health care consolidation, the Federal Trade Commission has been unsuccessful so far. However, there is another alarming trend that is less about consolidation and more about integration. Health plans and private equity investors are acquiring companies owned by doctors that directly provide care to patients at an alarming rate to form more vertically integrated networks. United's Optum is now the largest employer of physicians in America, eclipsing Kaiser. CVS/Aetna owns Oak Street and Signify. Humana has CenterWell. Walgreens owns Village MD. Elevance owns CareMore. Even internet retailer Amazon bought One Medical and Walmart is rumored to be looking at Medicare provider ChenMed. In addition, 65% of the purchases of physician practices between 2019 to 2023 were made by private equity firms. All of this points to corporations, both public and private, owning more physician practices, leading to less autonomy for physicians, greater friction between doctors, their patients and practice managers, and higher costs for employers—Mario Molina, Former CEO, Molina Healthcare and Principal, J. M. Molina Investment Company

Startups, Investments and the Business of Healthcare

If 2023 rumors have any weight, Cigna is one company that promises to be active in healthcare merger ... [+] and acquisition activity in 2024.

SOPA Images/LightRocket via Getty Images Value-Based M&A

Improving cost of capital, increased management team confidence in the ability to forecast, and narrowing price gaps between acquirers and targets support a more active U.S. Healthcare services M&A environment in 2024, for both strategic and PE players – albeit with parties exercising greater discernment about which assets merit a top-tier valuation. Consider it "value-based M&A."

Companies whose business model can be easily ported into the acquiror's will be highly coveted, given they enable multiple paths to value creation: helping an acquiror to profitably serve an attractive market and de-risking post-merger integration/synergies realization.

Also, as private equity seeks to deploy its dry powder into the next cohort of leading companies, investment committees will be especially focused on the durability of the exit valuation, looking holistically at a company's expected future competitive position as well as a range of exit multiples and transaction types—Ian P. Wijaya, Managing Director, Lazard Frères & Co.

The Privatization of Palliative Care Will Continue

There is money to be made all over Medicare Advantage, and supportive care for people with serious illness is no exception. In recent years we've seen explosive growth in programs that deliver a combination of primary and palliative care services under MA, usually through both in-home and telephonic care. There is no question that under traditional Medicare the reimbursement for home-based palliative care just doesn't add up, which means that MA is an avenue for new access to services for many patients. But there is also reason to be concerned.

With little visibility into the quality of care being provided, and a high-cost population that is a ripe target for profit under value-based MA plans, the rapid privatization of palliative care is worrisome. We have seen growing national attention to the (deleterious) effect of profit motive on quality in hospice and long-term care, but palliative care is not yet on the public's radar. So in 2024 we will see private companies continue to expand their footprint in the palliative care space, but we won't yet see substantive efforts to monitor and hold providers accountable for the quality of care they provide to a vulnerable population—Brynn Bowman, MPA, CEO, Center to Advance Palliative Care and Diane E. Meier, MD, Icahn School of Medicine at Mount Sinai

Consumerism in Healthcare

As we venture into 2024, the momentum towards building consumer-centric healthcare solutions is accelerating, with numerous companies, from established giants to nimble startups, steering this advance. The impetus behind this movement is multifaceted: empowering consumers to take control of their health, crafting seamless end-to-end solutions that deliver real value, retaining consumers amidst escalating competition, and providing holistic care.

Success in this space will depend on pivotal factors including: offering comprehensive solutions, as opposed to isolated products; fostering genuine patient partnerships by providing health data that is digestible, actionable, and leads to improved outcomes; and supporting payers with reimbursement strategies that offer straightforward and equitable consumer access.

As companies strive to offer solutions that are as intuitive as they are integral, the true measure of success will lie in their ability to create an ecosystem where convenience, accessibility, and partnership are not just added benefits but expected standards—Ayub Khattak, Chairman, President and CEO of Cue Health

Other Interesting Takes on Other Interesting Topics

Laborp's Adam Schecter believes healthcare costs as a percentage of GDP will decline. Do you agree?

getty Health Care Costs as a Percent of GDP Will Go Down

Health care costs as a percent of GDP will go down for the next several years in the US as we have cycled through the pandemic, which quickly accelerated cost, and we continue to see improvements in care and available treatments. New treatments such as weight loss drugs will increase costs for pharmaceuticals in the short term but decrease overall health care cost over time. A cautionary note is that although we may feel good that costs go down as a percent of GDP in the short term, the underlying growth which existed prior to Covid will continue and continue to be exacerbated by personnel shortages and the labor costs. We must find ways to increase quality while decreasing cost through the utilization of advanced technologies—Adam Schechter, Chairman and CEO, Labcorp

Medicaid Becomes the New Third-Rail in American Politics

A year ago, Larry Levitt, writing in JAMA Health Forum, proposed that Medicaid had replaced Medicare as the new "third rail" in American politics. The Affordable Care Act or Obamacare, as it has come to be known, expanded Medicaid and created the Marketplace for uninsured Americans who do not qualify for Medicaid. As of August 2022, about 90 million Americans were enrolled in Medicaid and CHIP while 65 million were enrolled in Medicare. Another 16 million Americans obtained their health insurance through Marketplace plans authorized by the Affordable Care Act. That means that about 1 of every 3 Americans relies on Medicaid or the Marketplace for some part of their health care. According to the Kaiser Family Foundation, in the upcoming 2024 Presidential election, more than 1 in 5 people in the swing states of Arizona, Nevada, Michigan and Pennsylvania rely on Medicaid. Attacking Obamacare again as he did in the past could doom former President Trump's chances to return to the White House and provide the lifeline that President Biden needs for re-election—Mario Molina

Patient Consumerism Will Result in Atypical Partnerships with Social Media Platforms

Increasingly, healthcare delivery organizations have relied on patient experience surveys to drive operational strategy. These surveys (often NPS, Press Ganey, and other tools) ask patients if they would recommend the organization to others in their network. Satisfaction scores are tracked over time, benchmarked and often tied to senior leadership incentive plans. However, patients have become much more vocal about their healthcare experiences and are more apt to use social media platforms to share stories that can significantly influence public perception of organizations – and potentially, market share. Hospitals happily share pictures of grateful patients with their clinicians and dancing women before they give labor. However, more dire stories have made national news, such as Dr. Susan Moore's Facebook livestream posts of alleged mistreatment before passing away after receiving inpatient COVID-19 care.

The power of the anecdote lies in the communication of raw and poignant emotion. Social media platforms such as Facebook or TikTok do not feature structured healthcare organization ratings (such as Yelp or Healthgrades), but are accessible to audiences that may not engage with standard rating or survey tools. Further, they offer capabilities such as the creation of pictures and videos to convey patient experiences that can be easily and rapidly reshared. If partnerships evolve between these types of platforms and healthcare organizations, the freedom of patients' thoughts and expressions will have to be heavily balanced with policies that navigate HIPAA laws, slander, or frank bias. Using multimedia feedback channels to better understand patient experiences and their organizational preferences might come down to 1 min video clips – and of course, hospital selfies—Amaka Eneanya, Chief Transformation Officer, Emory Healthcare

Medicare Advantage risk model changes will create a much tighter utilization environment

Medicare Advantage plans are facing the biggest challenge to reimbursement since the ACA passed in 2010. CMS is cracking down on the plan's ability to benefit financially from competitive advantages in coding. This will impact both MA plan and delegated provider profitability. Additionally, this is coming at a time when utilization of healthcare services for seniors is rising, in part due to self-inflicted wounds of poor benefit design of supplement benefits. Together these factors will create a need for managed care companies to manage care. The cost side of the equation becomes paramount and that will lead to tighter UM controls, additional emphasis on chronic care management and various other managed care techniques. All of this comes at the expense of the provider that will have to prepare for a more contentious relationship with their payor "partners."—Josh Raskin, Research Analyst, Nephron Research, LLC

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