Healthcare Prices and Payments UnitedHealthcare Pays Optum Providers More Than Non-Optum Providers Health Affairs Daniel R. Arnold, Brent D. Fulton Optum has a history of increasing market power through aggressive acquisitions of healthcare services and has been accused of using that market power to impede provider competition for financial gain.  UnitedHealthcare and Optum are parts of the same company, with UnitedHealthcare serving as the insurance arm, and Optum providing healthcare services.  In 2024, Optum, which includes a variety of smaller entities such as a pharmacy benefit manager (PBM) and software […]

The Source’s executive editor Katie Gudiksen, working with Arnold Analytics, co-authored a report on hospital market competition in Monterey County. The report was released today by California’s Office of Health Care Affordability (OHCA). The study examines why prices at CHOMP, Natividad, and Salinas Valley Memorial are among the highest in the state and finds that limited competition—not higher costs or better quality—is the main driver. It also outlines the impact on local families and employers and offers policy options for the state to consider. Read the full report here: https://hcai.ca.gov/wp-content/uploads/2025/11/OHCA-Investigative-Study-of-Hospital-Market-Competition-in-Monterey-County.pdf.

Health Care Consolidation and System Reform Health Care Consolidation: Published Estimates of the Extent and Effects of Physician Consolidation Government Accountability Office In 2023, Congress directed the Government Accountability Office to study the extent of healthcare consolidation, the potential role of private equity, and the effects on healthcare quality, access, spending, and costs. The GAO reviewed peer-reviewed empirical studies and reports from January 2021 through July 2025, and interviewed stakeholders, including physicians, hospitals, insurers, private equity firms, retail companies, and employees. The article cited available data sources, including PECOS, insurer […]

In 2025, the Oregon Health Authority (“OHA”) invited the public to weigh in on its Health Care Market Oversight (“HCMO”) Program.  The Oregon Health Policy Board is seeking comments on the program’s guiding principles and framework.  This move follows growing criticism and scrutiny of the program, as well as a lawsuit in which a federal appeals court upheld the program’s authority.  These public comment opportunities offer a rare chance for residents, providers, and stakeholders to directly influence how healthcare mergers, acquisitions, and affiliations are reviewed, or potentially restricted, by the […]

Primary Care Impact of primary care market mergers on quality: Evidence from the English NHS (Journal of Health Economics) Yuan Lyu, Zhaocheng Zhang This article examines the growing trend of market consolidation among primary care providers and assesses the impact of mergers and acquisitions on the English primary care market. The authors first look at the reasons behind primary care mergers.  They identify the three most significant issues as practitioners retiring (causing a small practice to merge with another), offices consolidating functions to practice more efficiently, and failing practices merging with […]

Impact of Federal Hospital Policies Sharp Rise In Urban Hospitals With Rural Status In Medicare (Health Affairs) Yang Wang, Jared Perkins, Christopher Whaley, Ge Bai This article aims to quantify the impacts of Geisinger Community Medical Center v. Secretary, United States Department of Health and Human Services, and Lawrence Memorial Hospital v. Burwell, which began allowing hospitals to qualify for both urban wage indexes for calculating Medicare reimbursements and Medicaid rural health policies designed to support rural healthcare.  The authors assess changes by tracking the proportions of administratively and geographically rural and […]

Healthcare Consolidation Defining Health Care “Corporatization” (The New England Journal of Medicine) Erin C. Fuse Brown In this brief article, Fuse Brown draws on the prescient work of Paul Starr who, in his 1982 book the Social Transformation of American Medicine, foretold the coming of large healthcare conglomerates. Through consolidation, concentration, and increased focus on profits over patients, the author asserts that we have reached the “Gilded Age” of medicine, replete with dissatisfaction for all – producers, providers, and consumers. While Starr’s 40-year-old prediction has proven to be largely accurate, Fuse […]

On July 3, 2025, a three-judge panel of the 9th U.S. Circuit Court of Appeals upheld an Oregon state law that allows the state to review, approve or deny proposed health care mergers, affirming a lower court ruling from May of last year. History of the Case The Oregon Association of Hospitals and Health Systems (OAHHS – a trade association representing Oregon hospitals and health systems) originally filed suit in Federal District Court October 2022 challenging the constitutionality of an Oregon law enacted in 2021, that required health care entities […]

Healthcare Cost Control State Health Care Cost Commissions: Their Priorities and How States’ Political Leanings, Commercial Hospital Prices, and Medicaid Spending Predict Their Establishment (The Milbank Quarterly) Brent D. Fulton, Daniel R. Arnold, Jordan M. Wolf, Richard M. Scheffler As healthcare costs continue to rise, states play an increasingly important role in addressing affordability and cost containment. In this Milbank Quarterly article, researchers examine the political and economic measures in the 17 states that have created Health Care Cost Commissions (HCCCs).  HCCCs are independent administrative bodies usually housed in the […]

Rural Healthcare Access Rural Hospital Closures Led to Increased Prices at Nearby ‘Surviving’ Hospitals, 2012-22 (Health Affairs) Caitlin Carrol, Jessica Chang Research on how consolidation affects healthcare pricing largely centers on mergers rather than closures. Hospital closures, especially those in rural areas, reallocate patient populations to nearby ‘surviving’ hospitals posing distinct effects on the remaining healthcare market. In theory, reallocation of a patient population can increase production efficiencies and lower costs at the remaining hospital, resulting in savings that could be passed to consumers in the form of lower prices. […]