February has been a busy month for state attorneys general from coast to coast, as AGs from Pennsylvania and California assert their authorities to regulate transactions in the healthcare provider market. On the drug pricing front, we follow up on the latest action in the nationwide litigation against the now infamous generic drug price fixing scheme that, fueled by increased media attention, has rallied state, federal, and private forces across the country.   Pennsylvania AG Sues Payer-Provider for Restrictive Network Access     In an effort to regulate Pennsylvania’s provider and …

With the share of Gross Domestic Product spent on health care reaching crisis levels,[1] experts on both sides of the political spectrum are demanding better value for the dollars spent on health care. Programs that give patients incentive to choose better value health care get widespread support from both political parties. In the past few years, many states considered enabling or implementing right-to-shop or savings reward programs, in which an insurer creates an incentive program that gives patients financial rewards for choosing providers with lower than average costs.   How …

Happy New Year! We hope this year is filled with good health (policy) and much happiness! In this roundup, we look at (1) proposals to address healthcare costs and competition, (2) changes to section 1332 waivers, (3) rising healthcare costs, premiums, and deductibles, and three articles specifically about telehealth from a special Health Affairs issue.   Proposals to Address Rising Healthcare Costs and Lack of Competition On December 3, the U.S. Department of Health and Human Services (HHS), in collaboration with the Departments of the Treasury and Labor, released Reforming …

Happy November! We hope you are enjoying football season and preparing for turkey! In this edition of the Source Roundup, we cover five academic articles and reports from October. The topics this month include (1) the popularity of telemedicine for employers and employees, (2) an integrated health care system that combines ACO and bundled payment, (3) health spending growth in the coming years, (4) Maryland’s new initiative reduced hospital utilization and costs, and (5) how to remedy recent generic drug price hikes.   Telemedicine Is More Widely Available, But Take-up …

A Texas high school teacher recently made headlines after getting a $108,951 bill when a heart attack sent him to an out-of-network hospital. The ambulance rushed Drew Calver to the nearest emergency center, which his insurance did not cover, leaving him with an astronomical surprise medical bill. Unfortunately, surprise medical bills are becoming a ubiquitous part of health care in America. The question is: why? Most people have insurance, but insurance doesn’t cover everything. So when Calver was treated at an out-of-network facility, his insurance paid only $55,840 towards the …

Welcome to October!  We hope you are getting your costumes picked out and finding those deals to stock up on trick-or-treat candy.  In this edition of The Source Roundup, we review five academic articles and reports from September that stood out to us.  This month we look at (1) price inflation in the California fully-insured large group market, (2) forward motion in drug price transparency laws, (3) the future of pharmaceutical reference pricing in the U.S., (4) lessons learned from California’s competitive healthcare model, and (5) paths to universal coverage …

Happy May! In this edition of the Source Roundup, we cover four academic articles and reports from March and April. The topics this month include: 1) the unfilled promise of price transparency to encourage price shopping, 2) FDA’s actions on prescription drug prices, 3) the phenomenon of overpayment for prescription drugs, and 4) results of Maryland’s All-Payer global hospital budgeting program.  Unfulfilled Promise of Price Transparency to Encourage Price ShoppingIn Promise and Reality of Price Transparency, a health policy report published by the New England Journal of Medicine, authors Ateev Mehrotra, Michael …

February brought us a number of interesting articles and reports on healthcare price and competition issues. This month’s Roundup covers publications about 1) projected growth in national healthcare expenditures|2) ACA state marketplace competition|3) the relationship between payment reform and provider consolidation|and 4) the impact of the ACA on individual’s ability to buy insurance. We hope you enjoy! Projected Growth in National Health Expenditures Health Affairs published a report on National Health Expenditure Projections: 2016 – 25 by Sean P. Keehan and colleagues. According to the report, healthcare spending will continue …

Last week, the Justice Department’s Antitrust Division, along with the North Carolina Attorney General’s Office, filed suit against Carolinas Healthcare System (“CHS”), challenging the large provider’s use of certain contract provisions in its agreements with insurers. DOJ claims that CHS, the dominant and most expensive provider in the Charlotte, North Carolina area, uses its market power to insist that the four largest insurers in the area agree not to steer their subscribers to lower-cost/higher-value providers. The last major DOJ case involving insurer-provider contracts was the Antitrust Division’s 2010 challenge to …

Happy June! In May, healthcare scholars discussed the usual topics of healthcare price, transparency, and hospitals. And, since the third open enrollment period ended February through April 2016, journals and foundations published multiple reports and articles on state marketplaces. Enjoy! HEALTHCARE PRICE The Journal of Applied Clinical Medical Physics published an article that seeks to answer the question: Why is health care so expensive in the United States? In this op-ed, the author, a “medical physicist” presents his opinions on why healthcare is so expensive in the United States. He …