Healthcare Competition and Consolidation Chang(ing) Health Care: Bigger May Not Be Better, Just Necessary (Health Affairs Forefront) Atul Grover, Jonathan B. Jaffery As the health care market increasingly trends towards consolidation, many have been left wondering whether the trend towards amalgamated efficiency truly is better. The authors of a new Health Affairs article are arguing that the answer is no. Specifically, they state that the trend towards larger, more consolidated entities is resulting in higher health care costs without marked improvements to quality. As health systems become larger, their power …

On October 18, 2024, the North Carolina Supreme Court unanimously ruled to send a case challenging the states Certificate of Need (CON) law back to a lower court.  Certificate of Need laws require healthcare providers and facilities to get permission from the state government before adding or expanding healthcare services, equipment, or facilities.  To get this permission, the provider must show that the new service is needed, hence the name. The case in North Carolina originated in April 2020 when Dr. Jay Singleton, an eye surgeon, filed suit against legislative …

On September 28, 2024, Governor Newsom approved Assembly Bill 2063. The provisions of the bill were originally enacted as AB 1124 in 2020, amends section 1343.3 of the Health and Safety Code regarding risk-bearing arrangement pilot programs. These programs, according to the bill’s author, Assemblyman Brian Maienschein, are a solution to increasing health care costs through shared financial risks.  Background The California Department of Managed Health Care (DMHC) regulates the licensure process in the state under the Knox-Keene Health Care Service Act of 1975 (KKA). Entities required to obtain a …

Healthcare Competition and Consolidation Are “All or Nothing” Contracts by Hospital Systems Anti-Competitive? – Evidence from a Recent Antitrust Lawsuit (Journal of Hospital Management and Health Policy) Glenn Melnick, Katya Fonkych Research has consistently shown that hospital prices are a major driver of increasing healthcare costs in the United States, with the expansion of multi-hospital systems contributing highly to this trend. While contracts between hospitals and health plans have been suspected to contribute to increasing prices, these assertions could not be confirmed until recently since many of these contracts have …

On September 23, 2024, Particle Health, a startup that aggregates and shares data among healthcare providers and health technology companies, filed suit in the U.S. District Court for the Southern District of New York against Epic Systems, the nation’s largest vendor of electronic health records.  The suit alleges that Epic is using its market power to destroy competition and represents a challenge to Epic’s dominance in the patient data marketplace. Parties to the Suit Epic is a software company that provides electronic health record (EHR) resources for hospitals and health …

On September 28, 2024, Governor Gavin Newsom vetoed Assembly Bill (AB) 3129. The landmark bill would have added restrictions around how private equity groups (PEGs) and hedge funds could participate in the ownership and management of California healthcare facilities. Introduced by Assemblymember Jim Wood and Attorney General (AG) Rob Bonta this past February, supporters of the bill had been optimistic about the bill’s potential impact on healthcare consumers and on the broader healthcare market. In this month’s California Legislative Beat, we examine how this bill could have changed healthcare transactions …

Healthcare Competition and Consolidation The Rise of Health Care Consolidation and What to Do About It (Health Affairs Forefront) Erin C. Fuse Brown, Yashawini Singh, Christopher M. Whaley, Jared Perkins As hospital consolidation continues to meteorically rise, an increasing number of government institutions including the Federal Trade Commission, the Department of Justice, and Congress, have diverted move resources towards understanding and responding to the negative impacts of these trends. The drive towards health care consolidation began in the 1990s and has resulted in a highly concentrated hospital market.  Increased consolidation …

On Saturday, Sept 18, 2024, Governor Gavin Newsom vetoed California AB 3129, legislation that would have created a requirement for the Attorney General to review and give approval before private equity groups could buy into certain health care facilities and providers (previously reported on by The Source). In his veto message, the Governor stated that the Office of Health Care Affordability (OHCA), established in 2022, “was created as the responsible state entity to review proposed health care transactions, and it would be more appropriate for the OHCA to oversee these consolidation issues as …

New laws and rules requiring greater transparency into the behaviors and reimbursements of insurers have given employees and employers a clearer picture of where their healthcare dollars are going.  For example, the “Transparency in Coverage” rule, implemented in October 2020, required health plans and insurers to post rates they negotiate with providers and develop price transparency tools related to cost-sharing.  The “Consolidated Appropriations Act”, passed in 2021, requires Third Party Administrators (TPAs) to provide notice of other compensation they receive to plan sponsors and restricts “gag clauses” that would otherwise …

Assembly Bill 2200, better known as the Guaranteed Health Care for All Act, which seeks to establish a universal single-payer healthcare system called CalCare has once again failed. Assemblymember Ash Kalra’s newest attempt at a single-payer bill is the most current in a long line of attempts to secure universal healthcare for Californians. In 2022, we wrote about Assembly Bill 1400, a single-payer universal healthcare bill that would see coverage expand to every resident within the state of California. 2022 was not the first time, nor the last, that state …