The story isn't new, and the players are still pretty much the same, but the difference is in how many players are actually left. Mergers and acquisitions in the healthcare industry show no signs of slowing, and the affects of any given merger can swing either way for providers. Here are some of the more recent heavy-hitting purchases:

• Multiplan: acquired by the Carlyle Group
• Beech Street: acquired by Concentra, who also owns Focus
• First Health/CCN: acquired by Coventry
• PacifiCare: acquired by United Healthcare (watch for memos from PREFERRED with more details in the next couple of weeks!)

PREFERRED is contracted with each of the PPO/Health plans mentioned above, and for the most part our agreements have not been significantly affected by the acquisitions - at this time. The majority of them continue to operate as independent networks or wholly owned subsidiaries of their new "parent" corporations, but are working behind the scenes to streamline operations by co-mingling their various departments and systems. In many cases, this means mass restructuring (layoffs) and an attempt to incorporate what are often very different business philosophies. Needless to say, integrations (especially on a massive level) don't always run smoothly, so expect a few glitches in provider relations support and claim payments before it's all over*.

While the immediate aftermath of the mergers and the general approach of "business as usual" looks fairly stable, it is eminent that some of these health plans and PPOs will be completely absorbed by their significant other, and providers will either be grandfathered in to all of the merged business, or will be completely left out of all of the merged business.

Prediction Number One:Some of these couplings of mega-players will mean more business for providers ... and possibly less reimbursement. The 8,000 pound gorillas will continue to throw their weight around to try and leverage deeper discounts now that they own even bigger chunks of the market.

Prediction Number Two: This may work short term, but providers will tire quickly of being strong-armed into a higher percentage of patients at lower rates. Providers need to cover their overhead costs without compromising time with patients (a practice is a business, after all)! Plans should be cautious of alienating providers, and providers need to know when to hold 'em and when to fold 'em.

Prediction Number Three:To some extent, the ongoing merger mania and heavy-hitter tactics will force providers to think outside the managed care box and diversify their service offerings to capture more of the consumer driven market and cash business as the dynamics of our healthcare system continue to morph.

*Noteworthy: Mergers are a very stressful undertaking particularly for the front line "folks" who are trying to blend different systems and often different business philosophies of the "top dogs", so please try to be patient with the health plan reps on the other end of the phone (don't kill the messenger)! With the exception of a few individuals here and there, they really are doing their best to help under some rather stressful conditions.