THE SOURCE BLOG

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 South Dakota page. South Dakota has been active in regulating prescription drug pricing and transparency. The state enacted a law to prohibit pharmacy benefit managers from prohibiting or penalizing a pharmacist for providing cost-sharing information on the amount a covered individual may pay for a particular prescription drug. The legislature also passed legislation …