THE SOURCE BLOG

As part of the Case Watch series for the landmark antitrust suit against Sutter Health, this post takes a look back at the Superior Court of San Francisco’s orders from March and June 2019, denying Sutter’s motions for summary judgment, which set the stage for the jury trial, set to begin on Thursday, October 10, 2019. As a preview of the legal arguments we will see at trial, we dissect each of the four causes of action brought against Sutter in the context of Sutter’s motions and the court’s rulings. …

The autumnal season is upon us!  This month, we pull no tricks, and treat you to a review of articles and reports about 1) the impact of healthcare market concentration, 2) the potential use for price transparency, and 3) government efforts to influence pharmaceutical pricing.   Conflicting Views on How Market Concentration Impacts Healthcare Prices Two recent reports point to an increase in healthcare market concentration and discuss the effects on price and competition.  The American Medical Association (AMA) just published the 2019 edition of the annual study of market …

Updated 10/14/2019: Governor Newsom has signed AB 651, which will take effect January 1, 2020.   There are few bills in the 2019 California Legislative cycle more supported by the Legislature than AB 651, which would reauthorize the Emergency Medical Air Transportation Act (“Act”) and prohibit balance billing by air ambulances. To fully understand the impact and significance of AB 651, we will first examine the history and evolution of the Emergency Medical Air Transportation Act, starting in 2010, to better appreciate the original intent of the Act. Second, we …

The lawsuit alleging anticompetitive conduct by Sutter Health is scheduled to begin trial on October 7, 2019 in the Superior Court of San Francisco. In the case, California Attorney General and private parties United Food and Commercial Workers union (UFCW) and Employers Benefit Trust (UEBT) allege that Sutter Health used its position as a dominant provider of hospital services in Northern California to demand anticompetitive contract terms from insurance carriers.[1],[2] Since the factual allegations and legal claims made in both the AG and private complaints are similar, the court consolidated the cases …

As states increase legislative efforts to rein in prescription drug prices, an increased number of laws have been passed to regulate pharmacy benefit managers, price gouging, and price transparency in the pharmaceutical industry. However, industry groups have also stepped up legal challenges against these laws, using specifically the Dormant Commerce Clause, ERISA, and federal patent and trade secret laws. With support from the National Academy for State Health Policy (NASHP), The Source’s Katie Gudiksen, Sammy Chang, and Jaime King examine these state laws and ensuing legal challenges in the newly …

Pennsylvania’s efforts to restore competition to the provider and insurance markets in the long-standing battle between University of Pittsburgh Medical Center (UPMC) and Highmark Health overcame mounting challenges and finally concluded with an unprecedented 10-year consent decree. The Source closely tracked the case as it unfolded over the past several months. In this post, we take a look back at the case’s long and winding road, which included three stops at the Pennsylvania Supreme Court, leading up to the new truce.   It’s Déjà Vu All Over Again It all began in …

Hello September! As we see cooler days slowly roll in, there are still many sizzling topics in this month’s health policy literature. In this Roundup, we take a dive into article and reports that discuss 1) the prevalence of surprise billing, 2) the effects of California’s AB 72 on provider networks, 3) increasing hospital prices, 4) hospital quality ratings, 4) increasing insurance premiums and out-of-pocket costs, and 5) health plan profitability.   Surprise Billing and Provider Networks Eric C. Sun, Michelle Mello, and Jasmin Moshfegh explore the current trends of …

Last month, we recapped the appropriations allocated to healthcare reform in the 2019 California Budget. These budget allocations, however, do not provide much guidance on how the money should be spent. Trailer bills provide the statutory language to implement the budget. With the enacted 2019 budget, the Governor signed two healthcare trailer bills passed by the Legislature, SB 78 and SB 104. In this post, we dissect these trailers bills which create and implement various programs impacting healthcare access and costs.   What are Trailer Bills? SB 78 and SB …

Hot off the press: Health Affairs Blog post The State Of State Legislation Addressing Health Care Costs And Quality highlights The State Laws Impacting Healthcare Cost (SLIHCQ) Database established by The Source on Healthcare Price and Competition and Catalyst for Payment Reform (CPR). The Source Executive Editor Jaime King and CPR Director Suzanne Delbanco discuss key approaches states are taking to develop high-quality, affordable health care, including transparency laws, payment reform and benefit design laws, laws that encourage provider competition, and laws that govern oversight and regulation of costs. Check …

Editor’s Note: As the historic antitrust lawsuit against healthcare giant Sutter Health heads to trial, The Source will feature a series of legal analyses, including revisiting the complaints and summary judgment order, to bring readers up to speed in this one of a kind case. The trial is set for September and expected to last around 12 weeks. Continue to follow The Source Blog as we bring the latest first-hand coverage and analysis in this case.    On August 6, the California superior court heard arguments on which antitrust analysis …