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Retail titan Walmart uses its market dominance to inflict “ruthless,” “brutal” and “relentless” pressure on prices charged by suppliers, business writers frequently report. What if huge health insurance companies could push down prices charged by hospitals and doctors in the same way? The idea is getting new attention as already painful health costs accelerate and major medical insurers seek to merge into three enormous firms. (Hancock, 8/11)

Instead of buying a health insurance policy to cover their workers, a growing number of small and midsized companies are opting to pay their employees’ medical claims directly, a potentially riskier practice financially called self-insuring, a recent study found. Between 2013 and 2015, the proportion of midsized companies with 100 to 499 employees that were self-insured increased 19 percent, to 30.1 percent, according to the analysis published in July by the Employee Benefit Research Institute. The percentage of small firms with fewer than 100 employees that self-funded their health plans grew 7 percent, to 14.2 percent, the study found. Meanwhile, self-funding by large companies declined slightly, to 80.4 percent. (Andrews, 8/12)

She’s one of a growing number of doctors who have cut loose from what she calls the “assembly-line, volume approach” and is now using a health care delivery model called direct primary care. She has scaled back the number of patients she sees and takes longer with the ones she does. She doesn’t take insurance and deals mostly in cash; she charges each time she sees a patient, but most direct primary care doctors charge a monthly fee for unlimited visits. In her previous practice, (Lorraine) Page says, the pressure to see more patients in less time wore her down, as did the need for an army of support staff to process the copious paperwork required by insurance companies. (Gorn, 8/11)

The long and bitter fight between a struggling rural health care system and Texas' largest insurer appears over as the flagship hospital in Tyler will now be included in the carrier's in-network group plans, both parties confirmed Thursday. East Texas Medical Center captured national attention when it took the extraordinary step of suing Blue Cross and Blue Shield of Texas and its Chicago-based parent company last summer in state court alleging that the insurer had plunged it into financial ruin and put patients with specialized needs at risk by shutting the main hospital in Tyler out of the most common and popular group health insurance network. (Deam, 8/11)