This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Indiana state page. Indiana made significant advances in promoting healthcare price competition and transparency in 2020.  Most notably, the legislature passed a law to mandate an all-payer claims database (APCD) that will include claims from Medicare, Medicaid or a Medicaid managed care organization, health maintenance organizations (HMOs), pharmacy benefit managers (PBMs), and other …

In the 2020 legislative session, California attempted to markedly expand the attorney general’s (AG) powers to intervene in healthcare acquisitions and changes of control. Senate Bill (SB) 977 would have required AG approval before for-profit healthcare entities could consolidate in California. The passage of SB 977 would have been historic and a massive step in antitrust enforcement in the healthcare industry. Unfortunately, SB 977 failed this session without ever being discussed in the Assembly or the Senate. In this post, we review what SB 977 could have done, why it …

This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Wisconsin state page. Wisconsin operates one of the largest private APCDs in the country, even though it is not mandated by statute. The Wisconsin Health Information Organization (WHIO), a private organization, gathers and makes healthcare claims data publicly accessible. With insurance claims data from sixteen commercial health plans and the state Medicaid program, …

This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Massachusetts state page. Massachusetts remains a leader on the healthcare cost containment, price transparency, and market regulation fronts.  Massachusetts’ Health Policy Commission (HPC), a unique and independent state agency, monitors healthcare spending growth in the state.  Based upon the data it collects, the Commission recommends delivery and payment reform policies with the goal of improving …

As unrelenting consolidation in healthcare provider and insurer markets continues, policymakers need additional options to protect the public from escalating healthcare prices and low-quality care. High healthcare prices result from multiple factors, including third-party payers dampening consumers’ price sensitivity, patients and providers demanding expensive healthcare technologies, and healthcare markets consolidating. While these factors are visible, dominant insurers and healthcare providers can also use terms in their insurer-provider contracts in anticompetitive ways that thwart competition and lead to higher prices or lower quality but remain hidden from public view. With support …

This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Nevada state page. The Nevada legislature convenes in odd-numbered years. For several years, Nevada law has required all healthcare plans to cover telehealth services for an insured to the same extent they would cover services provided by other means. This includes plans from managed care organizations (MCOs), health maintenance organization (HMOs), benefit contracts, and group …

This month in health policy research, surprise billing and changes in market structures fuel concerns about competition and consumer choice.  In addition, some studies on pharmaceutical costs produced hopeful reports.   Healthcare Market Competition and Consolidation Consolidation Trends In a Health Affairs study, Consolidation of Providers into Health Systems Increased Substantially, 2016-18, Michael Furukawa et al. analyzed provider consolidation trends.  The rate of physician affiliation with a health system increased by 11 to 51 percent in 2018.  Based on the 556 health systems the authors identified, the median number of …

See case page: UFCW & Employers Benefit Trust v. Sutter Health After much delay due to the pandemic induced hiatus, the preliminary approval hearing for the proposed settlement agreement in the Sutter Health antitrust case resumed on August 12 at the Superior Court of San Francisco. At the hearing, plaintiff attorneys on behalf of both class members UEBT and the Attorney General addressed in turn questions with respect to specific proposed terms raised in a tentative ruling by Judge Anne-Christine Massullo.[1] One key issue the court rested on was the selection …

Executive Editor Jaime King was quoted in the 7/30/2020 New Times San Luis Obispo article Big health: A look at how the Central Coast’s two hospital systems shape local health care costs: “The data is incredibly clear on this,” said Jaime King, a professor at UC Hastings College of Law who specializes in health care markets and policy. “Hospital mergers result in significant price increases almost immediately. Both entities’ prices go up as a result. Neighboring hospitals’ prices go up, too, as a shadow effect. It’s having an even bigger effect …

The Nevada Patient Protection Commission Presentation on drivers of healthcare costs and efforts to improve transparency in healthcare pricing Presentation: “Addressing High Health Care Prices: Transparency, Enforcement, and Legislation” Meeting Recording Meeting Minutes