THE SOURCE BLOG

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 Indiana state page. Indiana made significant advances in promoting healthcare price competition and transparency in 2020.  Most notably, the legislature passed a law to mandate an all-payer claims database (APCD) that will include claims from Medicare, Medicaid or a Medicaid managed care organization, health maintenance organizations (HMOs), pharmacy benefit managers (PBMs), and other …

In the 2020 legislative session, California attempted to markedly expand the attorney general’s (AG) powers to intervene in healthcare acquisitions and changes of control. Senate Bill (SB) 977 would have required AG approval before for-profit healthcare entities could consolidate in California. The passage of SB 977 would have been historic and a massive step in antitrust enforcement in the healthcare industry. Unfortunately, SB 977 failed this session without ever being discussed in the Assembly or the Senate. In this post, we review what SB 977 could have done, why it …

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 Wisconsin state page. Wisconsin operates one of the largest private APCDs in the country, even though it is not mandated by statute. The Wisconsin Health Information Organization (WHIO), a private organization, gathers and makes healthcare claims data publicly accessible. With insurance claims data from sixteen commercial health plans and the state Medicaid program, …

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 …

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 …

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 …

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 …

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 …

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 …

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 …