Spotlight on State: Massachusetts
Kendall Kohlmeyer, Student Fellow September 11, 2020
This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Massachusetts state page. Massachusetts remains a leader on the healthcare cost containment, price transparency, and market regulation fronts. Massachusetts’ Health Policy Commission (HPC), a unique and independent state agency, monitors healthcare spending growth in the state. Based upon the data it collects, the Commission recommends delivery and payment reform policies with the goal of improving …
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Just Published: Research Report on Preventing Anticompetitive Contracting Practices in Healthcare Markets
Amy Y. Gu, Managing Editor September 8, 2020
As unrelenting consolidation in healthcare provider and insurer markets continues, policymakers need additional options to protect the public from escalating healthcare prices and low-quality care. High healthcare prices result from multiple factors, including third-party payers dampening consumers’ price sensitivity, patients and providers demanding expensive healthcare technologies, and healthcare markets consolidating. While these factors are visible, dominant insurers and healthcare providers can also use terms in their insurer-provider contracts in anticompetitive ways that thwart competition and lead to higher prices or lower quality but remain hidden from public view. With support …
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Spotlight on State: Nevada
Kendall Kohlmeyer, Student Fellow September 4, 2020
This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Nevada state page. The Nevada legislature convenes in odd-numbered years. For several years, Nevada law has required all healthcare plans to cover telehealth services for an insured to the same extent they would cover services provided by other means. This includes plans from managed care organizations (MCOs), health maintenance organization (HMOs), benefit contracts, and group …
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Spotlight on State: Wyoming
Kendall Kohlmeyer, Student Fellow September 3, 2020
This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Wyoming state page. Wyoming was one of the first states to permit out-of-state regulated insurers to sell insurance products domestically to increase competition and decrease the cost to enter the market. Wyoming also requires studies of high hospital costs in the state, loss of medical services, and the use of out-of-state providers. While …
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Spotlight on State: New Series Feature Summaries of Healthcare Price & Competition Policies by State
Amy Y. Gu, Managing Editor September 3, 2020
The Source is launching a new series of “Spotlight on State” summaries to highlight notable legislation and initiatives in health policy and reform of all 50 states. Utilizing the SLIHCQ Database launched in partnership with Catalyst for Payment Reform, our goal is to update the overview summaries of each of the individual state pages on The Source, along with an exciting new feature of an overview infographic chart that provides an at-a-glance summary of existing and proposed legislation in each of the key issue topics for each state. The key …
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The Source Roundup: September 2020 Edition
Kendall Kohlmeyer, Student Fellow September 1, 2020
This month in health policy research, surprise billing and changes in market structures fuel concerns about competition and consumer choice. In addition, some studies on pharmaceutical costs produced hopeful reports. Healthcare Market Competition and Consolidation Consolidation Trends In a Health Affairs study, Consolidation of Providers into Health Systems Increased Substantially, 2016-18, Michael Furukawa et al. analyzed provider consolidation trends. The rate of physician affiliation with a health system increased by 11 to 51 percent in 2018. Based on the 556 health systems the authors identified, the median number of …
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Q&A: The What, When, Who and How of California’s New APCD: The Health Care Payments Data System
Mallory Warner, Health Policy Research Fellow August 17, 2020
Last month, we discussed California healthcare proposals that were postponed or cut due to budget constraints brought on by the pandemic-induced recession. California’s proposed all-payers claims database (APCD) project, the Health Care Payments Data (HPD) Program, was one proposal that survived. The passage of the HPD Program demonstrates the Legislature’s understanding that health care price transparency is important enough to withstand an extreme budget crunch. In this post, we take a look at the specifics of California’s new APCD and answer some important questions about its implementation and what it …
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[Sutter Case Watch] Sutter Health Preliminary Approval of Settlement Agreement Held up by Compliance Monitor Selection
Amy Y. Gu, Managing Editor August 13, 2020
See case page: UFCW & Employers Benefit Trust v. Sutter Health After much delay due to the pandemic induced hiatus, the preliminary approval hearing for the proposed settlement agreement in the Sutter Health antitrust case resumed on August 12 at the Superior Court of San Francisco. At the hearing, plaintiff attorneys on behalf of both class members UEBT and the Attorney General addressed in turn questions with respect to specific proposed terms raised in a tentative ruling by Judge Anne-Christine Massullo.[1] One key issue the court rested on was the selection …
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Surprise Billing: Proposed Federal Solutions From Both Sides of the Aisle
Source Fellow August 11, 2020
By: Danika Rothwell, Student Fellow Paul DeWolfe needed back surgery. He knew the operation would be covered by his insurance and was careful to make sure the hospital he chose was in his insurer’s network. DeWolfe sat down and did the math. He figured his portion of the bill would cost roughly $3,000. When DeWolfe recovered from his procedure, he was shocked to receive a bill for $18,590.83.[1] Despite all his attentive preparation, some of the physicians who treated him at his in-network hospital were, in fact, out-of-network. This story …
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The Source Roundup: August 2020 Edition
Kendall Kohlmeyer, Student Fellow August 3, 2020
The Source continues to extend wishes of safety and good health to you and your loved ones. This month, some policy and market considerations reflect on the Affordable Care Act in its tenth year, while others continue to focus on the COVID-19 pandemic and its projected long-lasting effects. Many experts share how and why the pandemic urgently necessitates healthcare system reform in the United States. The Affordable Care Act Last month, the Duke University Press Journal of Health Politics, Policy and Law published The Affordable Care Act’s Missing Consensus: …
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