Anticompetitive contracting practices have been under antitrust enforcement scrutiny from both state regulators and private parties in recent years. In California, hospital giant Sutter Health faced several high-profile lawsuits for its alleged anticompetitive contracts. While the state case led by the California attorney general settled earlier this year, the federal class action is on its way to the 9th Circuit appeal. HCA Healthcare, a large health system in North Carolina, appear to be the next health system under litigation fire for similar practices. Three separate actions have been filed by …

In this month’s Source Roundup, we start out with the latest articles and reports that examine consolidation and lack of competition in the healthcare markets, specifically 1) the impact of certificate of public advantage legislation and 2) the impact of dialysis consolidation on Medicare Advantage beneficiaries. We also highlight a few articles discussing healthcare prices and costs, including 3) the impact of inflation on the healthcare sector, 4) the divergence in cost growth between Medicare and the private insurance sector, and 5) factors that cause health spending to rise in …

This month, a long-standing private antitrust lawsuit against Blue Shield/Blue Cross came to a conclusion after a decade of litigation. After a favorable court ruling for the class plaintiffs on a key legal issue, the final settlement agreement received approval in federal court and provides both monetary and injunctive relief that is intended to boost competition in the insurance market. Filed in 2012 by employers and individual policyholders with Blue Cross/Blue Shield (BCBS) coverage, the putative class action alleges that BCBS entities conspired to divvy up insurance markets all over …

Summer may be going by like a breeze, but you can still catch up on some of the latest studies and reports in healthcare market and prices in the Source Roundup as usual. In this issue, we first take a look at the latest trends in hospital and health system consolidation. More than a year since the implementation of the federal hospital transparency rule, researchers continue to study and examine the hospital price data that were disclosed, including characteristics of hospitals that have complied with the rule, trends in prices …

On June 30, California Governor Gavin Newsom signed the 2022-2023 state budget, which includes a trailer bill (SB 184) that provides funding to establish the highly anticipated Office of Healthcare Affordability (OHCA) within the Department of Health Care Access and Information (HCAI). California joins a number of other states including Massachusetts, Oregon, and Rhode Island, as it becomes the latest state to establish a healthcare cost commission. This is a promising step forward in California’s efforts to control health care costs while ensuring high quality and broad accessibility. The main …

As federal agencies including the FTC and DOJ step up antitrust enforcement efforts in response to Biden’s executive order to revamp competition in the healthcare market, more and more healthcare entities are turning to less traditional consolidation that did not previously trigger antitrust scrutiny, such as “cross-market” mergers, which involve providers that do not directly compete in the same geographic market.[1] This month in Litigation and Enforcement Highlights, we take a look at the latest merger review and conditional approval of a proposed cross-market transaction in California, the third of …

This Blog provides supplementary comments on the recent Health Affairs article entitled “How Price Regulation Is Needed To Advance Market Competition” authored by Robert Berenson and Robert Murray.[1] The idea for the article was stimulated by conversations Bob Berenson and I have had in recent years regarding government administered pricing systems and market competition. Conventional U.S. health policy has asserted that these two approaches represent mutually exclusive strategies to address the issue of high and rapidly rising commercial health care prices. In our Health Affairs article, we attempt to refute …

Happy Summer! We kick off the holiday weekend with the latest research and articles in healthcare price and competition. This month’s Roundup highlights articles and reports that discuss 1) the impact and trends of private equity investment in health care; 2) compliance trends of the federal Hospital Price Transparency Rule; and 3) the role of high prices in excess healthcare spending in the U.S. and possible strategies for cost containment, including methods to limit costs and spending, such as 4) health savings accounts, 5) out-of-pocket spending limit for Medicare, and …

It’s been a busy month in healthcare antitrust land, both for federal regulators and private plaintiffs, as we saw an explosion of enforcement actions challenging both proposed mergers and anticompetitive conduct that stemmed from previous mergers. From New Jersey to Utah, large health systems such as HCA are being increasingly scrutinized and coming under fire for garnering and using their market power in anticompetitive ways.   Merger Challenges Fresh from its appeals court win in the Hackensack Meridian and Englewood merger challenge, the Federal Trade Commission (FTC) is continuing its …

This month’s Roundup highlights articles and reports discussing the need for improved, adequate monitoring of healthcare consolidation, including 1) vertical integration and joint contracting between physicians and hospital and 2) pharmaceutical mergers. We also examine articles studying healthcare cost affordability, specifically 3) the significant disparities in prices paid to hospitals by private plans and Medicare and 4) California’s improvements in healthcare affordability and access. Finally, we look at some proposed cost containment strategies such as 5) key areas to improve competition to reduce costs and 6) price caps on out-of-network …