Happy December! The holiday season is upon us and it is time to cozy up with a warm cup of tea to the latest health policy news.  This edition of the Source Roundup looks at articles on 1) healthcare market consolidation and provider network access, 2) increases in insurance premium contributions and deductibles, and 3) lessons from healthcare system reforms abroad.   Healthcare Markets Accountable care organizations (ACOs) have been lauded for providing higher quality medical care at lower costs.  In a recent Health Affairs research article, Changes in Physician Consolidation …

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 …

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 …

Medicaid health plans are often criticized for making too much money at the expense of tax payers and the indigent population, measured in billions of dollars.  However, real profitability goes far beyond the simple measure of profit dollars.  This post explores the profitability of Medicaid health plans from a corporate finance point of view, how the levels have changed over the years, and how they compare in today’s corporate context.   Beyond Profit Dollars: Evaluating Profitability on Operating Margin The public often focus on absolute profit dollars as a measure …

Happy August! Even as the summer winds down, there is no waning of health policy literature. In this month’s Source Roundup, we take a look at academic articles and studies that analyze 1) potential prescription drug savings from generics and biosimilars, 2) the need for price transparency, and 4) a multitude of efforts in health system reform.   Potential Prescription Drug Savings from Generics and Biosimilars As prescription drug pricing continue to capture the nation’s attention, Stacie B. Dusetzina et al. take a dive into cost discrepancies between brand name …

On June 27, 2019, Governor Newsom signed AB 74, the Legislature’s final budget with no line item changes related to health care. Previously, we glimpsed at the Governor’s May Revise and the Legislature’s final proposal. While not much has changed, we recap and delve deeper this month into specific programs under the enacted budget that could impact healthcare access and costs.   Final Allocations for New Healthcare Programs While many different healthcare initiatives are included in the enacted budget, we focus our discussion specifically on programs laid out in the …

Happy July! Hope everyone is staying cool in the summer heat. In this month’s Source Roundup, we take a dive into academic articles and studies that look at 1) healthcare system reform on a national and state level 2) health care markets concentration and competition, and 3) developing trends in prescription drug pricing.   Healthcare System Reform Ever since the Affordable Care Act (ACA) implementation nine years ago, it has become one of the most polarizing topics in American political culture, spawning debates both in support and in opposition of …