"These big boys [health plans] who are merging together,

... they are not waiting for January [when deals are expected to be final]; they are doing it now. They are going out to some of my physicians and saying, 'here is the contract for your renewal....You either sign this contract with a deep discount and all of these quality measures or we are going to pull all of our business away from your practice and send it to physicians who will. Now what this is is pretty heavy-duty Machiavellian contracting, but they have the muscle to do it with several insurers merging together, which could represent 30% to 40% of a doctor's practice. If they pulled everything out, the doc is going to have a hard time surviving. So the doc is going to have to knuckle under or they have to figure out some way to do this."

— Bill DeMarco, principal at Pendulum HealthCare Development Corp in Rockville, Ill., told AIS's Health Plan Week.