THE SOURCE BLOG

Editor’s Note: An abbreviated summary of this case appears in the research report “Preventing Anticompetitive Contracting Practices in Healthcare Markets”, which provides a detailed analysis of anti-tiering/anti-steering clauses, including economic justification and procompetitive use and states that have restricted its use in healthcare contracts.   The antitrust case against Sutter Health in California has drawn the attention of state regulators and policymakers across the country, spawning legislative reform efforts to curb dominant hospitals’ market power. Prior to this, an enforcement action against Atrium Health, a large health system on the …

On November 13, The Source on Healthcare Price & Competition and the UC Berkeley Petris Center jointly hosted a virtual convening of some of the leading experts in law and economics in a workshop to review and evaluate current findings of our collaborative research series “The Role of States in Promoting Competition in Healthcare: A Legal and Economic Analysis.” Our research analyzes how state merger review authority and regulation of contracts between providers and insurers affect the price of healthcare services and insurance premiums. The interactive workshop, supported by Arnold …

The private antitrust case against Blue Shield/Blue Cross (BCBS) reached a preliminary partial settlement last month after eight years of litigation. A driving force for this settlement may have been the April 2018 district court ruling that was seen as a serious blow to the defendants. In two antitrust suits that have been consolidated in Alabama federal court (put into Multi-District Litigation),[1] healthcare providers and employer subscribers sued BCBS companies across the country, alleging horizontal market allocation in violation of Section 1 of the Sherman Antitrust Act. The plaintiffs claim …

See case page: UFCW & Employers Benefit Trust v. Sutter Health In August, The Source reported on the preliminary approval hearing for the proposed settlement of California’s high-profile antitrust suit against Sutter Health. Among other issues, Judge Anne-Christine Massullo of the Superior Court of San Francisco was particularly troubled by the selection process of the independent compliance monitor and required supplemental filings from the parties regarding the selection and outreach process employed in the selection of Jesse Caplan of Affiliated Monitors, whom the parties jointly requested to appoint (see The Source …

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 Kansas state page. Kansas was one of the first states to mandate an all-payer claims database (APCD). In operation since 2010, the Data Analytic Interface (DAI) is maintained by the Kansas Department of Health and Environment (KDHE) and the Division of Health Care Finance (DHCF) and collects medical, dental, and pharmacy claims, eligibility files and …

Two papers published by The Source were cited in the latest Milbank Memorial Fund report “California’s Sutter Health Settlement: What States Can Learn About Protecting Residents from the Effects of Health Care Provider Consolidation”. The first, “Addressing Health Care Market Consolidation and High Prices”, is co-authored by The Source’s Jaime S. King and Katherine L. Gudiksen, with Robert A. Berenson et al. for the Urban Institute. The second paper is “Preventing Anticompetitive Healthcare Consolidation: Lessons From Five States”, written by Jaime S. King, Samuel M. Chang, et al. and jointly published …

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 …

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 …

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 …

See case page: UFCW & Employers Benefit Trust v. Sutter Health At a July 9 hearing at the Superior Court of San Francisco, Judge Anne-Christine Massullo denied Sutter Health’s motion to delay the approval hearing of the preliminary settlement agreement due to the COVID-19 pandemic. This is an encouraging ruling as there was much speculation and concern that Sutter’s request is a thinly veiled attempt to walk back the historic settlement reached last December amidst the chaos of COVID-19. In a California Healthline quote last month, The Source Executive Editor …