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Major Insurers See Antitrust Enforcement Action Headed to Appeals
Amy Y. Gu, Managing Editor January 17, 2023
We ended 2022 with an update on trends in healthcare provider consolidation and enforcement actions. In this inaugural 2023 issue of Litigation and Enforcement Highlights, we turn to the latest action in healthcare payer enforcement and litigation. Major insurers UnitedHealth and Blue Cross Blue Shield experienced similar antitrust woes lately, as both insurers saw their seemingly finalized lawsuits headed to the appeals court. UnitedHealth Merger Challenge Continues Post-Acquisition The UnitedHealth and Change Healthcare merger lawsuit grabbed headlines at the end of last year. The deal was officially consummated in …
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The Source Roundup: January 2023 Edition
Amy Y. Gu, Managing Editor January 3, 2023
Happy New Year, Source Readers! We kick off 2023 with highlights of some reports and articles that you may have missed from December. In surprise billing protection efforts, the implementation of the No Surprises Act is hitting unexpected backlogs in the IDR process, while the loophole of ground ambulance surprise bills also warrants further policy attention. Reports on healthcare spending and out-of-pocket costs suggest that healthcare is becoming less affordable as out-of-pocket costs continued to rise. Lastly, a pair of studies on value-based payment models reveal flaws in the systems …
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Healthcare Consolidation Q4 2022: Cross-Market Mergers Continue Apace
Amy Y. Gu, Managing Editor December 15, 2022
2022 has been an active year in healthcare consolidation as well as for merger challenges and enforcement. As we approach the year end, healthcare deals continued as many entities seek to close the transactions before the new year. Increasingly, as seen in the 4th quarter, healthcare deals are shifting to cross-market transactions, making review and enforcement efforts more challenging. In case you missed it, this final Litigation and Enforcement Highlights of the year will help you catch up on some of the cross-market deals in Q4 2022 that caught our …
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Office of Health Care Affordability: California’s Healthcare Cost Commission Gears Up for Implementation
Rachel Ng, Student Fellow and Amy Y. Gu, Managing Editor December 14, 2022
In the 2022 session, California enacted legislation to create the state’s healthcare cost commission, the Office of Healthcare Affordability (OHCA). As part of the Department of Health Care Access and Information (HCAI), OHCA is authorized to analyze the health care market for cost trends and drivers of spending and set and enforce cost-growth benchmarks for the state. It also has the authority to review and assess the impact of mergers, acquisitions, affiliations, and other healthcare transactions on price and competition. As OHCA prepares for its launch, the California Health Care Foundation …
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The Source Roundup: December 2022 Edition
Rachel Ng, Student Fellow December 1, 2022
As the end of the year approaches, there’s no better time to catch up and reflect upon new research and findings from the past year. The articles and reports in this month’s Roundup examine the latest trends in consolidation including (1) the rise of cross-market hospital systems and (2) concentration in the insurance markets. We also highlight articles that explored (3) the current state and future of telehealth regulation and (4) quality impact for hospitals that switch to a value based payment model. Consolidation and Competition Although 2022 has …
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The Source Launches New “Provider Rate Regulation” Interactive Key Issue Pages
Amy Y. Gu, Managing Editor December 1, 2022
The Source on Healthcare Price & Competition is thrilled to announce the launch of the newest interactive key issue pages in Provider Rate Regulation. Along with a report published in Frontiers in Health Services, this series of key issue pages aim to provide state policymakers with a roadmap of effective strategies to address rapidly increasing prices. In many markets, where existing competition are insufficient to constrain the pricing power of dominant insurers and providers, policymakers need to consider options to directly limit the unrelenting increase of healthcare prices that threatens the affordability of health care for Americans. With support …
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The Source and Various Stakeholders File Amicus Briefs Urging 9th Circuit to Reverse Jury Verdict of Sidibe v. Sutter Health on Appeal
Amy Y. Gu, Managing Editor November 15, 2022
See case page: Sidibe v. Sutter Health After the state action UEBT v. Sutter Health settled prior to trial, the Sidibe class action in federal court continued to shine the spotlight on hospital giant Sutter Health. In March 2022, a jury verdict in the Northern District Court of California cleared Sutter of anticompetitive allegations in this decade-long case. Class plaintiffs swiftly filed an appeal in the Ninth Circuit Court of Appeals to overturn the decision, citing inaccurate jury instructions and exclusion of key evidence that impacted the final outcome of …
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Recapping the 2022 California Legislative Session: What Was and What Wasn’t – Part 2: Promoting Telehealth and Tackling Out-of-Network Costs and Prescription Drug Prices
Amy Y. Gu, Managing Editor November 13, 2022
In the previous issue of the California Legislative Beat, we recapped noteworthy bills from year two of California’s 2021-2022 legislative term, specifically legislation that sought to regulate healthcare competition and ensure affordable access (see Recapping the 2022 California Legislative Session – Part 1). In this second part of the two-part series, we turn to bills that aimed to eliminate surprise out-of-network costs, advance telehealth, and rein in prescription drug prices, including ones that were signed into law and some important ones that didn’t make the cut. Surprise Out-of-Network Costs …
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Recapping the 2022 California Legislative Session: What Was and What Wasn’t – Part 1: Regulating Competition and Ensuring Affordable Access to Care
Amy Y. Gu, Managing Editor November 7, 2022
Year two of California’s 2021-2022 legislative term came to an end last month as the Governor signed 997 bills into law and vetoed 169. The state considered healthcare bills that were rolled over from 2021 as well as new ones that were introduced in 2022. At the end of the 2021 session, The Source recapped noteworthy bills impacting healthcare price and competition that were enacted (see blog post). In the 2022 session, the legislature again made efforts to promote healthcare access and affordability in California through several legislative themes. In …
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The Source Roundup: November 2022 Edition
Rachel Ng, Student Fellow and Amy Y. Gu, Managing Editor November 1, 2022
In this month’s Roundup, we highlight some noteworthy articles and reports that discuss 1) state options for provider rate regulation and their potential pitfalls such as regulatory failure and regulatory capture; 2) consolidation trends in the hospital market and pharmaceutical industry; 3) price transparency efforts including compliance with the hospital and insurer transparency rules and the state-federal partnership to implement the No Surprises Act; and 4) drivers of national health spending. Provider Rate Regulation With the rapid consolidation of health care providers and highly concentrated insurance markets, consumer bargaining …
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