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Spotlight on State: Virginia
Amy Y. Gu, Managing Editor May 4, 2021
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 Virginia page. Virginia is an active state in promoting price transparency in health care. Virginia operates an All-Payer Claims Database and provides other datasets online relating to cost and quality, including the average charge data for 25 of the most frequently reported health care services. All medical facilities and health maintenance organizations are required to …
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The Source Roundup: May 2021 Edition
Erin Livinghouse, Student Fellow May 3, 2021
This month’s roundup covers academic articles and reports that examined: 1) early results and challenges of the new federal price transparency rule; 2) how to address increasing market consolidation and competition during the COVID-19 pandemic; 3) rising healthcare costs; and 4) how much patients pay and physicians receive when patients receive out-of-network emergency care. Price Transparency In response to policymakers calling for greater price transparency of healthcare services for patients and other payers of healthcare, a federal rule from the Department of Health and Human Services took effect on …
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Spotlight on State: West Virginia
Amy Y. Gu, Managing Editor April 29, 2021
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 West Virginia page. West Virginia has made progress in healthcare price transparency on several fronts, including implementing an all-payer claims database, passing legislation easing access to medical records, and creating annual financial disclosure requirements for facilities in order to determine the reasonableness of healthcare costs among providers. The state earns a high grade …
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United Health Care Accused of Using Market Power for Financial Gain, Impeding Provider Competition in Texas and Colorado
Amy Y. Gu, Managing Editor April 15, 2021
This month in Litigation and Enforcement Highlights, we dive into a pair of healthcare antitrust lawsuits that is making the headlines. In late March, a group of doctors sued United Healthcare Insurance in Colorado and Texas in state courts, alleging the insurance giant violated state antitrust laws. Plaintiffs U.S. Anesthesia Partners (USAP) is a physician practice group made of anesthesiologists who practice in nine states. In the complaints, they claimed that United Healthcare used its market power to “squeeze” the group out of its insurance network and the marketplace for …
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2021 California Healthcare Bills Part 2: Prescription Drug Pricing and Price and Quality Transparency Initiatives
Mallory Warner, Health Policy Research Fellow April 14, 2021
Last month, we highlighted California’s proposed healthcare bills from this legislative session that focus on healthcare market and system reform measures. This month, we’re covering more proposed healthcare bills that focus on prescription drug pricing regulation and price transparency. The bills outlined in this post were designed with the health care consumer in mind and are attempts to curtail excessive health care bills and pharmaceutical pricing, while increasing transparency around consumer’s healthcare plans. Prescription Drug Pricing Regulation Americans spend more on prescription drugs than any other country. In response …
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The Source Contributes to Model State Legislation to Prohibit Anticompetitive Healthcare Contracts
Amy Y. Gu, Managing Editor April 13, 2021
In connection with the Source’s research and findings on anticompetitive contract terms, Senior Health Policy Researcher Katie Gudiksen co-authored the NASHP model legislation for states to rein in the use of these contract terms, including all-or-nothing, most-favored nation, anti-steering/anti-tiering, and gag clauses. A companion report, A Tool for States to Address Health Care Consolidation: Prohibiting Anticompetitive Health Plan Contracts, further details the contract terms and how the model act can give states essential tools to create a more level playing field and help rein in rising health care costs. For …
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The Source Commissioned for Policy Analysis of Rhode Island Health System Consolidation
Amy Y. Gu, Managing Editor April 12, 2021
As an extension of the Source’s research and work on provider market consolidation, the Milbank Memorial Fund commissioned the Source team to conduct an in-depth policy analysis of health system consolidation in Rhode Island and provide legal and regulatory options for Rhode Island state officials to address the impacts of consolidation. Executive Director Jaime King, Senior Health Policy Researchers Robert Murray and Katie Gudiksen, and Source Advisory Board Member Bob Berenson of the Urban Institute created a detailed presentation that first provides an overview of Rhode Island’s provider markets and …
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Spotlight on State: New Hampshire
Amy Y. Gu, Managing Editor April 12, 2021
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 New Hampshire page. The state of New Hampshire is a trailblazer that is highly active in considering innovative cost containment solutions and expanding price transparency initiatives. New Hampshire created one of the nation’s first all-payer claims databases (“APCD”) in 2003 to collect and disseminate healthcare price information, leading the way for many other …
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Spotlight on State: North Dakota
Amy Y. Gu, Managing Editor April 8, 2021
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 North Dakota page. North Dakota is one of the few states that bans most-favored nation clauses in provider contracts. It is also one of the even fewer states that prohibits most noncompete agreements, by making them generally unenforceable. Specifically, state law provides that a contract by which anyone is restrained from exercising a …
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The Source Roundup: April 2021 Edition
Erin Livinghouse, Student Fellow April 1, 2021
Happy April! This month’s roundup centers on articles and reports that discuss: 1) healthcare markets and competition; 2) payment reform, and 3) healthcare costs, and 4) price transparency. Healthcare Markets and Competition In a piece published in the Harvard Business Review titled The Pandemic Will Fuel Consolidation in U.S. Health Care, Lovisa Gustafsson and David Blumenthal, researchers at the Commonwealth Fund, predict that mergers of key players in the U.S. healthcare system will continue as a result of provider financial challenges during the COVID-19 pandemic. While the Federal Trade …
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