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 Welcome to Today in Health It where we explore the latest developments in healthcare information technology. I'm Kate Gamble, and joining me as always is Sarah Richardson. Sarah, welcome to the show.

Thank you, Kate, because we're gonna jump into a topic that's making waves in the healthcare space. An antitrust lawsuit filed against Penn Medicine regarding its exclusive contract with Independence Blue Cross, or IBX. We

are putting on our legal hats for this story, which first broke in the Daily Pennsylvanian and it touches on some big themes, healthcare, competition, payer provider contracts, and access to care.

So we're gonna break it down and share some key takeaways, and most importantly, talk about why this matters to you as a healthcare

IT leader. So the basics In this one, two Philadelphia area, residents filed a class action lawsuit claiming that Penn Medicine has engaged in monopolistic behavior by only accepting independence.

Blue Cross Insurance.

Exactly, and this is a big deal because Penn Medicine is one of the region's largest and most influential providers By working exclusively with one payer, the plaintiffs argue that patients are left with fewer affordable care options, especially if their employer doesn't offer IBX.

It also raises the question, should dominant health systems be allowed to limit access to just one insurer for HIT leaders, this is a reminder of. How data transparency and also interoperability are gonna intersect with your payer strategy.

So let's talk about patient choice. The lawsuit claims that this exclusivity not only affects pricing, but also limits access, particularly for those with non IBX insurance who might be forced to go out of network for critical services and shoulder that financial burden that comes with it.

And this is a direct threat to health equity, which you and I are consistently focused upon because as the CIO or even one of the digital health leaders in an organization, this is the nudge to ask, are we leveraging our digital tools to expand or restrict care access? Are partnerships improving patient access or are you locking patients out and you're probably a patient in your healthcare system, in a geography where you live? So it's also interesting to consider how it could affect you personally. And I'm a big fan. I've always put your patient hat on first.

Yeah, that's a great point. And it's also important to look at Penn Medicine's role in this. So Penn Medicine. Defends the agreement saying that the exclusivity allowed them to negotiate lower rates with IBX and improve quality through deeper integration.

But this is where it gets interesting because from a system efficiency standpoint, exclusive contracts can streamline billing, reduce administrative overhead, and improve clinical coordination.

But at what cost, Kate?

This is a classic value versus volume debate and one that is definitely taking place in a lot of boardrooms.

That number looks to increase this year, and as providers merge and large systems consolidate, there's an increasing scrutiny on how that affects pricing and competition.

Exactly. So the FTC has been much more aggressive in monitoring hospital and insurer mergers, and this case could be a bellwether for how courts view exclusive contracts going forward.

So for the HIT team sitting around their own table, it underscores why neutrality and standards matter in data access. So if your platform only works with one partner or one insurer, what happens to patient continuity when legal wins shift? This is a big conversation in the democratization of data within organizations and having sources of truth of your data that are governed by people outside of it with the IT teams.

This is huge and we're gonna be hearing more about this going forward, , but zooming out a bit, if Penn Medicine is forced to unwind, its exclusivity, it could trigger wider disruptions in how contracts are structured across the country. It

also puts a spotlight on. Digital health startups of which there are an abundance continuously, and the interoperability of the platforms and these point solutions.

So there's a major opportunity here for tools that facilitate care across networks and don't rely on payer exclusivity.

So the big takeaway is that health, it isn't just supporting care anymore. It's enabling or inhibiting access. And leaders have to be part of

that ethical conversation. So if you're the C-Suite leader, think about the conversations you're having with your payer partners.

Are you focused solely on cost savings and performance metrics, or are you also thinking about patient autonomy and freedom of choice?

And for those who are in analytics and digital transformation, what is your data say about access? Are certain zip codes, insurance types, or demographics falling through the cracks?

Chances are they are.

Chances are yes. And this also ties into data liquidity and APIs. So as Teca rolls out and Q hands gain ground, we're moving into a world where exclusivity may become technologically irrelevant. Patients will expect their data and care to follow them.

Another related area, price Transparency mandates.

You and I discussed this a few weeks back, the executive order instructing the Departments of Health and Human Services, labor and Treasury to implement and enforce price transparency requirements. If this is implemented and patients are able to shop around exclusive agreements like the one in Philly, might lose their power naturally over time.

So that's something to consider. So for our listeners, here's your homework. Bring this question to your next leadership huddle. Do our partnerships help or hinder patient choice? And be prepared to really listen to the responses

and ask your teams, are our systems architected to serve the patient or the contract?

Big questions, and they're not just philosophical questions. These are strategic. So as this case evolves, it could reshape how payer provider relationships are built nationwide.

One other thing to consider, Kate, is often technologists will be focused on the backend. The parts about, are we able to exchange data thoughtfully?

Are we able to flex to new contracts? And I really want anyone who listens to today in health it to be leaning into the business, the operations, and the finance aspect of what technology is serving. Because we are gonna get more and more granular on these types of topics and the implications they will have both.

By state and federally. And so when you know the downstream effects of decisions being made and how that affects the technology, then you're more prepared to be thoughtful in the broader conversation. Every IT leader should want to be a part of that broader conversation.

That's really well said. And this particular example was from Philadelphia, but it is happening in a lot of other places, and we're going to hear more about it.

So that's it for today's episode. Join us tomorrow when we discuss A HRQ merger raises questions about the future of safety and quality work. Don't forget to share this podcast with a friend or 📍 colleague. Use it as a foundation for daily or weekly discussions on the topics that are relevant to you and the industry.

They can subscribe wherever you listen to podcasts. Thanks for listening. And that's a wrap.