New laws and rules requiring greater transparency into the behaviors and reimbursements of insurers have given employees and employers a clearer picture of where their healthcare dollars are going.  For example, the “Transparency in Coverage” rule, implemented in October 2020, required health plans and insurers to post rates they negotiate with providers and develop price transparency tools related to cost-sharing.  The “Consolidated Appropriations Act”, passed in 2021, requires Third Party Administrators (TPAs) to provide notice of other compensation they receive to plan sponsors and restricts “gag clauses” that would otherwise …

In the last issue of California Legislative Beat, we examined some significant bills from year one of California’s 2023-2024 legislative term. Specifically, we focused on legislation that sought to make changes in healthcare competition, consolidation, and system reform. In part 2 of the 2023 session recap, we turn our attention to bills that aimed to tackle healthcare service and pharmaceutical costs, coverage, and price transparency.   Healthcare Costs and Coverage Californians can expect to be protected from surprising dental or emergency ground medical transportation bills soon. The legislature approved and …

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 …

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 …

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 …

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 …

Articles and reports published in the first month of 2023 saw an increased focus on the impact of consolidation as well as private equity investment in health care. Researchers also continued to examine factors impacting health care pricing and explored potential policy options available to the states to address provider prices, including a specific call for legislative intervention in the Western Pennsylvania market.   Healthcare Consolidation Recent years saw an interesting shift in healthcare consolidation: mergers and acquisitions are becoming increasingly low-volume but high-value and cross-market. In Kaufman Hall’s report …

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 …

On October 27, The Source Executive Editor Katie Gudiksen will join a panel of experts for the Bipartisan Policy Center in a virtual event on “Taming Health Insurance Costs for Employers and Employees”. The panel is moderated by Health Affairs Editor-in-Chief Alan Weil and will discuss strategies to rein in health care costs and allow employers to provide high-value, cost-effective insurance to their employees. Be sure to register in advance here! October 27 | 1:00 – 2:00 p.m. ET | Virtual Participants: Marilyn Serafini (introduction), Executive Director, Health Program, BPC …

Fall is upon us, and the time is better than ever to sip on a cup of tea (or coffee) and catch up on some of the latest articles and reports! In this month’s Source Roundup, we cover a variety of topics in healthcare price and competition. First, we shine the spotlight on the rise in private equity acquisitions, particularly of physician practices and ambulatory surgical centers, and highlight some of the latest studies that examine the implications of these acquisitions on healthcare cost and spending, utilization, and quality. Second, …