Health Care and Life Sciences

Health Insurance Services

Health Insurance Services

Besides a large number of hospital mergers, NERA's Health Care Practice has analyzed the competitive effects, both vertical and horizontal, for numerous health insurance mergers. We have also worked on litigations involving exclusive contracting and exclusive dealing issues as well as analysis of subscriber and provider class actions against insurers. NERA health economists have:

  • Advised several insurers on whether some providers are behaving or pricing anticompetitively in their contract negotiations;
  • Advised a hospital system with a large HMO of its own on how to deal with non-integrated insurers seeking to contract for the system's facilities and non-integrated hospital providers seeking to contract with the system's health plan;
  • Analyzed relevant market issues and the competitive effects of affiliations between major health insurers, for example, Aetna's acquisition of Prudential and Pacificare's acquisition of FHP;
  • Analyzed the competitive effects of alleged physician boycotts against major health insurers;
  • Analyzed the potential for exclusive provider contracts and most-favored-nations provider contracts with a health insurer to facilitate monopolization by the insurer;
  • Analyzed and provided assistance to counsel in several class action suits against managed care plans over the insurer's proper disclosure of member benefits and physician reimbursement methodologies as well as over adequate notification of the insurer's dropping out of the Medicare-Choice program in a particular county; and
  • Defended several insurers accused of anticompetitive exclusions of some providers from their networks.
Name Title Location Phone Email
Dr. Lawrence Wu President San Francisco +1 415 291 1007 lawrence.wu@nera.com
Dr. Anne Gron Managing Director Chicago +1 312 573 2850 anne.gron@nera.com
Dr. Thomas McCarthy Managing Director
Health Care Practice Chair
Los Angeles +1 213 346 3005 thomas.mccarthy@nera.com
Dr. Elizabeth Newlon Associate Director Los Angeles +1 213 346 3019 elizabeth.newlon@nera.com
Title Type Author
Paper Trail: Review of a Recent Working Paper on the Effect of Copay Coupons on Drug ... Published Article The Antitrust Source
Do Not-For-Profit Firms Behave Differently? Book Chapter
Competition and Innovation in Health Care Markets and Their Implications for Antitrus... Published Article By Dr. Lawrence Wu with former NERA Senior Consultant Dr. Rika Mortimer
Antitrust Issues Between Payers and Providers Published Article By Dr. Thomas McCarthy with Dr. Scott Thomas
A New and Uncertain Future for Managed Care Mergers: An Antitrust Analysis of the Aet... Published Article By Dr. Lawrence Wu with Robert Bloch and Scott Perlman
The Evidence Is In: A Review of the Market Definition Debate in Hospital Merger Cases... Published Article By Dr. Lawrence Wu
Risk-Adjustment and Its Implications for Efficiency and Equity in Health Care Systems... Report By Dr. Thomas McCarthy with Keith Davies, John Gaisford and Ullrich Hoffmeyer