A few yr in the past, UnitedHealth Group's Optum introduced plans to amass residence well being care firm Amedisys for about $3.3 billion, beating out Choice Care Well being. The deal could be an all-cash transaction for $101 per share. The announcement got here as a number of healthcare firms are making strikes into the house well being care area, together with CVS Well being and Walgreens.

However issues haven’t been easy crusing for Minnetonka, Minnesota-based UnitedHealth Group and Baton Rouge, Louisiana-based Amedisys. The U.S. Division of Justice (DOJ) has been scrutinizing the deal, and the Oregon Well being Authority has launched an investigation to see if the deal would hurt folks in Oregon. The DOJ has additionally reportedly opened an antitrust investigation into UnitedHealth Group (UHG).

In late June, nonetheless, Amedisys introduced in a submitting with the Securities and Change Fee that Amedisys and UHG had entered into a purchase order settlement to promote sure Amedisys residence well being facilities and sure UHG care facilities to VCG Luna, a subsidiary of VitalCaring Group. The divestiture of the undisclosed variety of care facilities is contingent upon the completion of the merger between Amedisys and UHG, which is anticipated to shut within the second half of 2024, the submitting mentioned.

Will the transfer reassure the DOJ and immediate it to approve the Amedisys-UHG merger? The company didn’t reply to a request for remark, and UHG declined to remark. However a number of specialists mentioned they imagine the deal is more likely to undergo — probably with some minor modifications.

“I feel they’re making an attempt to surrender as little land as potential with out doing greater than they need to. If I have been a betting man, I’d wager there’s likelihood the deal will undergo as deliberate, or perhaps with minor changes,” mentioned Dr. Robert Pearl, former CEO of the Permanente Medical Group and present professor at Stanford College Faculty of Drugs and Stanford Graduate Faculty of Enterprise, in addition to an creator and podcaster on well being care.

These changes might embody divesting extra residence well being facilities, however doubtless not many extra, Pearl added. For instance, Amedisys and UHG might initially divest 100 facilities (though the precise quantity is unknown). However the authorities might say that’s not sufficient and inform them to divest 20 extra, in response to Dr. Adam Brown, an emergency drugs doctor and founding father of ABIG Well being. However the divestments would doubtless nonetheless be within the residence well being sector, since that’s the place UHG and Amedisys overlap.

Nevertheless, Pearl famous that this divestment from VitalCaring more than likely occurred after a interval of negotiations, so “all of the items are in place until one thing sudden occurs — like Congressional or presidential intervention.”

One other skilled agreed that there might be additional divestments past this preliminary deal, however it’s “extra doubtless than not that [the merger] will proceed.”

“If there are different steps they should take, I feel they'll work towards that, as a result of Optum appears fairly inclined to undergo with the deal and do what they should do to make that occur,” mentioned Tyler Giesting, president of well being care and life sciences at West Monroe in Chicago. “So I might say it's extra doubtless than not, however you may by no means know for positive.”

One business skilled: Hal Andrews, President and CEO of Trilliant Well being — famous that it’s “doubtless that UHG obtained a ‘nod within the head’ that the proposed divestments could be ample.”

That mentioned, “predicting what occurs in Washington, DC proper now could be a bit like shaking the Magic 8 ball — particularly in an election yr,” he added.

Whereas a number of specialists say the merger between Amedisys and UnitedHealth Group is more likely to undergo in the long run, Brown stays involved concerning the merger's implications.

“I’m deeply involved concerning the rising management UHG is exerting over the U.S. healthcare system,” Brown mentioned in an electronic mail. “UHG already operates the nation's largest personal well being insurer and controls a considerable community of physicians. Their affect and market dominance make negotiating or competing with them extraordinarily difficult.

“The DOJ’s investigation into this explicit merger is important, however we should additionally take into account the broader implications,” he continued. “UHG’s latest Change Healthcare hack underscored the monetary and affected person care challenges throughout the business. At what level will we acknowledge that UHG is changing into a ‘too massive to fail’ behemoth that we proceed to feed?”

UHG has certainly grown exponentially through the years, elevating greater than $41.4 billion from 26 acquisitions since its founding in 1977, together with Change Healthcare (acquired in 2022), LHC Group (acquired in 2023) and DaVita Medical Group (acquired in 2019). It additionally employs or contracts with 1000’s of physicians and owns OptumRx, one of many prime three pharmacy profit managers. Its insurance coverage arm, UnitedHealthcare, controls 15.7% of the medical health insurance market.

Pearl mentioned he’s undecided UHG is essentially a foul man. Quite, it’s the complete healthcare system as an entire that should change. He reiterated what he instructed MedCity Information in an earlier interview.

“I feel UnitedHealth Group is the most important, so it’s going to be focused,” Pearl mentioned beforehand. “However it’s not intrinsically — so far as I do know — a extra problematic firm than some other firm in well being care. I feel it’s the damaged system that everyone’s making an attempt to work round, making an attempt to plug the holes, and having a number of middlemen concerned.”

Picture: AndreyPopov, Getty Photos