The Framework Already Exists. The Question Is Whether Anyone Will Use It
The Californer/10349213

SACRAMENTO, Calif. - Californer -- Ninety percent of health system markets in the United States are now classified as highly concentrated. The providers own the market, and they know it. Price signals do not work when one system controls the landscape. Market forces, left alone, will not fix what market failure built.

Peter Hayes spent more than 25 years navigating that reality from the buyer's side. As Director of Associate Health and Wellness at Hannaford Supermarkets, he managed one of New England's largest self-insured benefit plans before serving as President and CEO of the Healthcare Purchaser Alliance of Maine, appointed by two governors to Health Care Reform Commissions. He no longer believes the market can solve this.

He sat down with host Vincent Catalano on the CLEARly Beneficial Podcast, released Tuesday, June 2, 2026.

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What It Would Actually Take

Hayes came with a concrete agenda: rate caps on hospital growth, population-based health payments, a halt to vertical integration, and state-level regulatory action. Washington, he argued, is too compromised to lead.

"We have allowed so much vertical integration and it's too big to fail. Market forces will not work because 90% of health system markets are highly concentrated. They own the market."

This episode covered: why market forces have failed; rate caps and population-based payment models; the Consolidated Appropriations Act and plan sponsor liability; the 340B drug program and how an $82 billion revenue stream lost its public purpose; tax-exempt hospital status; and broker compensation reform.

The Wall Street Journal Called the Next Day

After an employee's knee replacement failed three times, became infected, and cost the plan over a million dollars, Hayes restructured the benefit. Employees who traveled to Singapore - where the procedure ran $10,000 with a one-year warranty - received full coverage, including travel for a significant other.

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"The Wall Street Journal picked up the article. The next day I got calls from hospitals all across America." A Maine hospital asked to match the standards. They did.

When the Healthcare Purchaser Alliance of Maine, representing 60 percent of commercial lives in the state, began waiving cost-sharing for Leapfrog A or B rated facilities, Maine went from one of the most unsafe hospital markets in the country to national recognition for safety.

"Employers are getting sick of paying premiums at the level they're paying," Catalano added. "That cannot go to $2,000 a single in the next five years. I don't know where the revolt starts, but it will start."

Tune In to the Podcast

• Substack - https://clearlybeneficialpodcast.substack.com
• YouTube - https://www.youtube.com/@CLEARlyBeneficialPodcast