Health Care

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. Subramaniam (Subbu) Ramanarayanan Senior Managing Director New York City
Los Angeles
+1 212 345 0745
+1 213 346 3038
subbu.ramanarayanan@nera.com
Dr. Elizabeth Newlon Managing Director Los Angeles +1 213 346 3019 elizabeth.newlon@nera.com
Dr. Paul Wong Managing Director San Francisco +1 415 291 1030 paul.wong@nera.com
Dr. Emily Walden Director Washington, DC +1 202 466 9220 emily.walden@nera.com
Brigid Jung Senior Consultant New York City +1 212 345 7039 brigid.jung@nera.com
Dr. Thomas McCarthy Affiliated Consultant Los Angeles +1 213 346 3000 thomas.mccarthy.affiliate@nera.com
Title Type Author
The Algorithmic Accountability Act: Potential Coverage Gaps in the Healthcare Sector Published Article Dr. Andrew Stivers and Dr. Gabriella Monahova
The Role of Rebates in the Pharmaceutical Industry Published Article Dr. Chris Stomberg
Non-Compete Agreements: Might They Be Procompetitive in Health Care? Published Article Dr. Paul Wong and Dr. Emily Walden
Drug Rebates: A Peek Behind the Curtain at Drug Prices Published Article Dr. Christopher Stomberg
Taking Stock of the Efficiencies Defense: Lessons from Recent Health Care Merger Revi... Published Article Dr. Subramaniam Ramanarayanan
Paper Trail: Review of a Recent Working Paper on the Effect of Copay Coupons on Drug ... Published Article Bryan Ray and Dr. Subbu Ramanarayanan
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