Sometimes, as they say, a picture is worth a thousand words. This is a chart from a recent investor presentation showing the market share of the dominant provider group in Massachusetts.
As I have said before, this represents excellent execution of a business strategy formulated in the mid-90s, when this system was founded by a corporate affiliation of Brigham and Women's Hospital and MGH. It has resulted in a behemoth, and the state's largest insurer has said publicly that it does not have the ability to withstand the resultant market power -- and acts that way, too.
The chart shows only tertiary discharges, reflecting the 4,000 licensed beds and 6,560 physicians in this system, with operating revenues of $8.5 billion in fiscal year 2011. So, when you read a story about this system being vulnerable to the poaching of a 90-doctor group by a cash-laden private equity firm, you really have to wonder. Especially when the story notes: "Compass doctors send many of their patients to the Brigham for advanced care, and doctors intend to continue that relationship."
How convenient, though, for the dominant player when such an event happens. It can spin the story and assert that this shows how market forces are at work.
In other regions characterized by similar market dominance (e.g., Utah with Intermountain Health; parts of Wisconsin with Gundersen Lutheran, parts of Pennsylvania with Geisinger), the local provider systems have demonstrated an agenda of controlling the growth of health care costs by focusing on improving quality and safety and process improvement. This Massachusetts system could have and still could exercise similar leadership, but not if it continues to execute the old growth model.