CMA clears NHS healthcare tech deal 

The Competition and Markets Authority (CMA) referred UnitedHealth’s £1.2bn purchase of EMIS for an in-depth Phase 2 investigation by an independent inquiry group in March 2023, after identifying competition concerns that warranted further investigation during an initial Phase 1 review.

Following a thorough investigation, the CMA has today confirmed that the transaction does not raise competition concerns when considered against the higher legal standard that applies in Phase 2 investigations, clearing the deal to proceed.

The NHS is increasingly seeking digital and data-driven solutions to help improve the delivery of healthcare in the UK. EMIS supplies data management systems to the NHS, including the electronic patient record system used by most NHS GPs in the UK. Optum, part of the US healthcare giant UnitedHealth, currently supplies software used by GPs when prescribing medicines, as well as data analytics and advisory services that the NHS uses to help improve overall healthcare and health service provision.

Although the merging businesses do not supply competing services, the CMA was initially concerned that the deal would allow Optum to limit its competitors’ access to the data held within EMIS’s patient record system or to degrade the digital connections to this system, which rivals rely on to provide integrated software.

The investigation confirmed that EMIS, as the lead supplier to NHS GPs across the UK, holds a particularly strong market position in the supply of electronic patient record systems. But further evidence-gathering and analysis, considering the potential impact of the merger in two markets in which Optum could limit its competitors’ access to the data held within EMIS, has found that the deal does not raise competition concerns.

In the supply of data analytics and advisory services for Population Health Management, the CMA found that the merged business would not, in practice, be able to use the data that EMIS holds to harm the competitiveness of rivals, primarily because the NHS could use its oversight role to prevent the merged business from pursuing this kind of strategy.

In the supply of medicines optimisation software, the CMA found that a strategy that involved restricting access to EMIS’s electronic patient record system would not be commercially beneficial to the merged business, with any possible gains being limited and capable of being reduced through intervention by the NHS.

Kirstin Baker, chair of the independent inquiry group carrying out the investigation, said:

“The NHS increasingly relies on digital technology and data analytics to support the delivery of high-quality healthcare. So, it is important to ensure that, as the main customer of these services, the NHS continues to have access to the options and innovations that new and developing technology can bring.

“Following a thorough investigation, careful consideration of a broad range of evidence and consultation with a variety of stakeholders, we are satisfied that this deal will not reduce competition or mean that the NHS and its patients lose out.”

More information can be found on the CMA’s Optum/ Emis case page.

Notes to editors

1. Optum is part of UnitedHealth Group Incorporated a large US healthcare insurance, healthcare, and health data analytics business. In the UK, UH operates through Optum Health Solutions (UK) Limited (Optum) and provides:

   • Medicines optimisation (MO) software: MO software suggests alternatives to doctors when they are prescribing medication in order to increase effectiveness and reduce costs.

   • Population health management (PHM) services which encompasses a broad range of products and services that use data analytics and advisory services to improve physical and mental health outcomes across a population and healthcare provision.

2. EMIS is an established UK-based healthcare software business that provides a range of IT solutions to the NHS, including a primary care electronic patient record (EPR) system, EMIS Web. EMIS Web allows GPs to manage appointment bookings, conduct patient consultations, and update, store and share patient records. EMIS also offers EMIS-X Analytics (EXA) software which allows users to conduct data analysis.

3. The CMA’s Phase 1 investigation started on 20 January 2023 after the companies announced the acquisition in 2022. The deal was referred for a Phase 2 investigation on 31 March 2023 and provisionally cleared on 11 August 2023.

4. The CMA gathered and assessed a wide range of evidence, including thousands of internal business documents from EMIS and Optum. The CMA also gathered evidence from requests for information and calls with competitors as well as customers across the NHS and from NHS England, including following its consultation with stakeholders following the provisional findings.

5. In a Phase 2 review, the inquiry group considers whether it is more likely than not that a deal will substantially lessen competition – a higher threshold than Phase 1. Accordingly, some mergers that are referred to Phase 2 will ultimately be cleared.

6. A further explanation of Population Health Management can be found on the NHS website.

7. For more information, journalists should contact the CMA press office by email on press@cma.gov.uk or by phone on 020 3738 6460.

8. All enquiries from the general public are directed to the CMA’s General Enquiries team on general.enquiries@cma.gov.uk or 020 3738 6000.