Consolidation and Competition A Doctrine in Name Only — Strengthening Prohibitions against the Corporate Practice of Medicine (NEJM) Jane M. Zhu, Hayden Rooke-Ley, and Erin Fuse Brown The NEJM perspective examines state corporate practice of medicine laws that prevent ownership or control of physician practices by corporate entities. In an accompanying audio interview, Erin Fuse Brown discusses the role of these laws, including the usefulness and how they could be strengthened. Competition in Commercial PBM Markets and Vertical Integration of Health Insurers with PBMs: 2023 Update (American Medical Association) José R. …

After much debate fueled by disagreement over California’s $31.5 billion deficit, lawmakers and Governor Newsom have finalized the state’s 2023-2024 budget. The final budget bill outlines a $310 billion spending plan that includes $248.1 billion for Health and Human Services programs,[1] up from $245.69 billion in the May Revision.[2] Stakeholders can breathe a sigh of relief: core health programs will not face budget cuts, and California’s commitment to health care generally, and Medi-Cal in particular, remains strong. Consistent with the proposed budget in the May Revision, California continues to move …

Our roundup of studies and reports for this month focuses on healthcare costs and consolidation, including a paper written by The Source teama examining state action to regulate healthcare mergers and acquisitions. We also share two studies relating to impacts of consolidation and acquisition; one compares post-surgery outcomes in high and low concentration markets, and the other takes a broad view of costs and quality at acquired hospitals. Next, a systemic review analyzes trends and impacts of private equity acquisition and a study compares hospital prices paid between Medicare Advantage …

This month’s roundup of studies and reports highlights growing consolidation in health care as well as increasing costs of care. One report predicts higher medical costs in 2024—a trend that continued from the last two years. Another report highlights that policy efforts to reduce facility fees charged by hospitals are a potential avenue for controlling costs. Global capitation, in particular one value-based model utilized in Maryland, may help reduce the cost of specialty care delivery. Meanwhile, trends in the size of physician practices and recent M&A activity are indicators of …

Summer is here, and we hope you can enjoy some vacation time. Whether you’re at work or on the beach, our July roundup brings you the highlights of recent healthcare pricing and competition studies and reports. First, we share several articles that discuss the potential for anticompetitive impacts from consolidation through collaborative agreements and cross-market mergers, two types of lesser-examined transactions that more easily escape regulatory scrutiny. Next, we share an American Hospital Association fact sheet that spotlights insurer policies and acquisitions as under recognized contributors to the changing landscape …

On May 12, California Governor Gavin Newsom released the May Revision to his January proposal for California’s 2023-2024 budget. The so-called “May Revise” lays out a $306.5 billion budget for total state funds,[1] up from $296.9 billion in January’s proposal.[2] The higher budget also includes a higher deficit due to unexpectedly low tax revenues:[3] the plan now anticipates a $31.5 billion shortfall,[4] about $10 billion more than predicted in January.[5] Despite the deficit, the revised budget proposal avoids cuts for core health programs and services,[6] as the Governor continues to …

In the previous issue of the California Legislative Beat, we examined healthcare bills introduced in the 2023-2024 legislative term that target healthcare consolidation and competition in California (see 2023 California Healthcare Bills – Part 1). In this second part of the two-part series, we explore some newly proposed bills that seek to increase access to care, control costs, and improve transparency in data and prices.   System Reform and Access California is a leader in innovative healthcare policy and initiatives, particularly to increase patients access to care while lowering overall …

With the healthcare market at the most consolidated it has ever been, both federal and state action is needed to ensure health care systems provide high-quality, affordable care that is accessible. In this month’s roundup, we begin with several publications authored by The Source team on the ramifications of consolidation and the role of federal and state antitrust enforcers. Researchers also considered whether health care providers and insurers have returned to pre-pandemic performance levels. With the rise of health care spending and health care costs, understanding these trends becomes especially …

California’s Medi-Cal program is the largest Medicaid program in the country. It is tasked with providing care for approximately 15 million enrollees, or one third of California’s population. To ensure affordability while maintaining quality and improving health care outcomes, CalAIM was created as California’s newest approach to reform Medi-Cal, including changes to managed care plans and reimbursement of behavioral health plans. Although many of these objectives under CalAIM are still in the initial implementation stages, the potential ramifications of this multi-year, billion-dollar investment in changing how millions of people receive …

This month’s Roundup focuses on articles and reports examining price transparency efforts at both the state and federal levels as well as new recommendations for policymakers on effective healthcare cost containment strategies. States continue to address the lack of knowledge available to the public with all-payer claims databases. Federally, the implementation of new price transparency rules requiring reporting from health care providers and insurers have been examined for compliance and limitations. In addition to price transparency, to get to the bottom of healthcare affordability concerns, researchers and experts are suggesting …