Comment from Robin Goracke (Executive Director at the Independent Coalition of Advanced Risk Entities)

The Independent Coalition of Advanced Risk Entities welcomes the opportunity to comment on the joint public inquiry regarding potential additional guidance on collaborations among competitors. We appreciate the Federal Trade Commission (FTC) and U.S. Department of Justice’ (DOJ) thoughtful work on this notice and recognize the complexity of balancing competition policy with the evolving structure of the healthcare system. The Independent Coalition of Advanced Risk Entities (ICARE) represents independent, physician-led organizations that assume advanced financial risk and accountability for patient outcomes across Medicare Advantage and other value-based care arrangements. Our members strongly support competition, innovation, affordability, and the continued transition toward accountable, value-based care models that improve patient outcomes while reducing avoidable costs. We believe an important distinction must be made between pro-competitive clinical integration that improves care coordination, quality, and affordability, and anti-competitive consolidation that concentrates market power and disadvantages independent physician organizations seeking to compete on value. This distinction is critical to preserving a competitive and sustainable health care marketplace. Independent physician-led risk organizations are uniquely positioned to advance many of the Administration’s health care priorities, including prevention, chronic disease management, reduced hospital utilization, and lower total cost of care. Yet these organizations increasingly face structural barriers created by accelerating consolidation among insurers, pharmacy benefit managers (PBMs), hospital systems, and physician practice management platforms. Importantly, evidence continues to demonstrate that properly structured value-based care arrangements can improve outcomes and reduce unnecessary utilization. For example, Humana reported that Medicare Advantage beneficiaries aligned with value-based physicians experienced improved preventive care, better health outcomes, and lower costs relative to non-value-based arrangements . ICARE supports these goals. However, independent physician-led organizations increasingly face an uneven competitive environment that threatens the long-term viability of independent value-based care delivery. As the FTC itself has previously recognized, vertical integration may create competitive concerns where dominant entities control referral pathways, physician networks, or access to patients and data . ICARE members increasingly express similar challenges raised by independent pharmacies and other market participants during prior FTC and DOJ proceedings involving vertically integrated health care markets . Independent advanced-risk providers frequently bear significant financial accountability for patient outcomes and total cost of care without receiving equivalent transparency, bargaining leverage, or operational visibility. In practice, this results in the transfer of insurance risk to physician organizations without corresponding access to the information and tools necessary to compete effectively. ICARE respectfully urges the FTC and DOJ to continue distinguishing between physician-led accountability and care coordination that enhance competition, and consolidation strategies that foreclose independent competitors and reduce consumer choice. To support competitive, patient-centered value-based care markets, ICARE encourages consideration of the following policy principles: •Increased transparency in Medicare Advantage risk contracting, including standardized methodologies for attribution, benchmarking, and quality measurement; •Improved interoperability and timely access to claims and utilization data for independent risk-bearing providers; •Scrutiny of self-preferencing, steering practices, and discriminatory contracting behavior that disadvantages independent physician organizations; •Enforcement efforts focused on anti-competitive conduct rather than organizational size alone; and •Policies that preserve pathways for independent physician-led organizations to participate successfully in advanced-risk and accountable care arrangements. Competition policy should ensure that independent physician organizations can compete based on quality, affordability, outcomes, and patient experience, not simply ownership structure or market concentration. The future of value-based care should not require physicians to sell their practices to vertically integrated conglomerates in order to survive financially. A competitive health care system should preserve opportunities for independent physician-led entities to innovate, coordinate care, and assume accountability for outcomes while remaining independent. We appreciate the opportunity to provide these comments and would welcome further engagement with the Agencies on these issues. Sincerely, Robin Goracke Executive Director