The health sector saw its share of fireworks this year even before the Fourth of July.
The springtime was characterized by contention, with the antitrust fight to determine the future of the CVS-Aetna merger dragging on in federal court, the Trump administration backing a Texas lawsuit to declare the Affordable Care Act unconstitutional, nationwide debate over 'Medicare for all' and powerful payer and provider lobbies jockeying to influence surprise billing legislation.
The first half of 2019 saw a slew of mergers and acquisitions. Though the pace of consolidation has slowed somewhat, Centene made a $17 billion grab for WellCare and Sanford and UnityPoint plan to merge into an $11 billion integrated health system, showing big deals are still in play.
Amazon continued to dominate the conversation as its prescription delivery arm PillPack netted more state licenses, teasing a national rollout. The Amazon-Berkshire Hathaway-J.P. Morgan troika to lower costs gained a name, Haven, and a new website gave just a hint at what the secretive venture might be planning.
Government wasn't idle either. CMS was active in the spring, introducing new primary care payment models in a bid to inject more risk into a risk-averse system, adding flexibility into Medicare Advantage plan offerings and opening its arms to tech. Red and blue states alike wobbled in a balancing act between Medicaid expansion under the Affordable Care Act and work requirements.
President Donald Trump signed a controversial executive order to require hospitals to publish negotiated rates with insurers and industry to provide patients with out-of-pocket cost estimates, and opened the door to bedrock changes in the way the country covers its employees with an HRA rule set to go into effect in 2020.
And industry reacted to all this disruption with pledges to do things differently.
Here are Healthcare Dive's top stories from the first half of what promises to remain an interesting year.
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'Meet PillPack': Amazon rolls out Rx delivery direct marketing
In April, e-commerce behemoth Amazon began marketing PillPack's at-home prescription drug delivery to American consumers. Though a lot of questions remain unanswered about the offering, the ads seem targeted to people with chronic conditions and are a first look into the tight-lipped market mover's foray into the space.
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Mixing medicine and money: Why the rise of health system VCs is raising ethical concerns
Financial incentives shape healthcare like any other industry, but this deep dive chronicling the case of medtech company Gauss Surgical is a snapshot into the ethical issues that arise when health systems and doctors play a role in developing products.
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How AI could shape the health tech landscape in 2019
This piece on futuristic technology stoked reader interest at the beginning of the year, illustrating how the myriad applications of artificial intelligence and machine learning are beginning to move from talk to action.
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Aetna launches app for Apple Watch
Aetna rolled out its app for the Apple Watch in May. The collaboration combines wearable and claims data to allow users to set personalized goals and earn financial rewards for healthy behavior, showing that, despite the lack of scientific evidence that wearables actually improve your health, they're a hot market segment right now — and insurers are showing interest.
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CVS exec: 'We don't discount Amazon'
CVS's EVP and chief policy and external affairs officer provided a rare insight into how the healthcare giant, in the midst of integrating payer Aetna, views one of its largest and most disruptive competitors.
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Private equity sees ripe opportunity in healthcare this year
Private equity firms have been eager to snag a piece of the $3.5 trillion health industry pie, with orthopaedics, mental health and addiction treatment among the most tempting slices. According to financial data firm Pitchbook, private equity deals in healthcare have more than doubled over the past decade, and 2019 has proved to be another busy year.
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Centene 'committed' to WellCare deal amid Humana takeover report
Amid rumors of challenges with Centene's snap-up of managed care firm WellCare, the payer remains committed to the deal. The marriage, if finalized, would make Centene a formidable player in government-sponsored health plans: doubling its Medicare footprint and making it the leader in Medicaid managed care with over 11 million members nationwide.
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Amazon's senior leader of healthcare and AI talks disruption, Amazon Web Services
Healthcare Dive chatted with Amazon's senior leader of healthcare and artificial intelligence at HIMSS in February about his role at the company, its web, cloud and AI services and some perennial issues in the health IT sector.
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Civica Rx CEO predicts 'stampede' if Amazon's Haven succeeds
Civica Rx CEO Martin Van Trieste said disruption caused by Amazon should be cheered and imitated, illustrating that some healthcare players welcome outside interference if there's a chance it can lead to positive change.
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What's at stake in CVS-Aetna merger hearing: 4 questions
The companies are acting as one and all signs point to the merger being completed, but one roadblock stands in its way: U.S. District Judge Richard Leon. What's the scope of his review? Can he really do anything about it? Why is this unusual and why does this matter for the future of antitrust proceedings? Healthcare Dive jumped into these thorny questions.