The Boston market is on the cusp of a dynamic shift in power with two major mergers shaking up the landscape for the first time in decades. A merger creating Beth Israel Lahey Health is completing its first year, and the state is reviewing a proposed merger between two nonprofit insurers that will give market leader Blue Cross Blue Shield of Massachusetts new competition it has never experienced. Payment reform initiatives are well established and extensive in Boston, but challenges still remain. The market embraces value-based care and boasts a healthy population and some of the highest-quality care in the nation, but it also has high prices and above-average hospital utilization and readmissions rates. The MassHealth Medicaid program also drives reform as it implements a multibillion-dollar overhaul of the Medicaid program that moved most members into ACO plans. Look for drug companies to alter spending habits as a new drug pricing review law forces drug companies to provide more transparency around prices and price increases. Expect this new oversight to build as lawmakers look to additional legislation and regulatory proposals impacting drug pricing.


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