Competition
DOJ & North Carolina AG Target Same Insurer-Provider Contract Clauses as California’s Sutter Plaintiffs
Anne Marie Helm, Managing Editor June 14, 2016
Last week, the Justice Department’s Antitrust Division, along with the North Carolina Attorney General’s Office, filed suit against Carolinas Healthcare System (“CHS”), challenging the large provider’s use of certain contract provisions in its agreements with insurers. DOJ claims that CHS, the dominant and most expensive provider in the Charlotte, North Carolina area, uses its market power to insist that the four largest insurers in the area agree not to steer their subscribers to lower-cost/higher-value providers. The last major DOJ case involving insurer-provider contracts was the Antitrust Division’s 2010 challenge to …
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Sutter Plaintiffs Picking Up Steam in CA Antitrust Case
Anne Marie Helm, Managing Editor April 29, 2016
See UFCW & Employers Benefit Trust v. Sutter Health case page. Last fall, we updated you on a key California case brought by self-funded payers against Sutter Health, the dominant health care provider in Northern California, styled UFCW &|Employers Benefit Trust v. Sutter Health. At that time, the litigation had been hamstrung by Sutter’s attempts to take the dispute to arbitration, which ultimately were unsuccessful, landing the parties back in state court in San Francisco County. Two years after the plaintiffs filed their complaint in April 2014, the court denied Sutter’s …
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Sutter loses appeal re arbitration|must litigate against union in state court
Anne Marie Helm, Managing Editor April 28, 2016
See UFCW & Employers Benefit Trust v. Sutter Health case page. The Source has been following UFCW &|Employers Benefit Trust v. Sutter Health, since the complaint it was filed in state court in San Francisco in April 7, 2014. A grocery store union is the named plaintiff in the putative class action whose class includes all self-funded payers in California who compensated Sutter for acute care services while the company was engaging in anticompetitive practices alleged to violate California’s antitrust law, the Cartwright Act, and other state statutes relating to unfair …
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Academic Articles & Reports Round Up: March 2016
Elizabeth Nicholson, Research Fellow April 1, 2016
Happy Spring! A common theme among the healthcare articles and reports, published in March, was payment reimbursement systems (fee-for-service versus value-based systems) and Accountable Care Organizations (“ACOs”). In addition, typical healthcare topics were also reported on. These include healthcare cost|insurance cost|healthcare competition|and suggested improvements for the United States healthcare system. As a bonus, a few articles and reports focused on healthcare cost and competition issues in other countries. FEE-FOR-SERVICE REIMBURSEMENT MODEL Health Affairs posted an article entitled Fee-For-Service, While Much Maligned, Remains the Dominant Payment Method for Physician Visits. The article’s …
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House Passes Bill to Lessen FTC Merger Enforcement Powers in Name of Standardization
Anne Marie Helm, Managing Editor March 29, 2016
There seems to be a fair amount of disagreement in Washington lately over the federal merger review process. On the one hand, the American Antitrust Institute is calling for increased merger enforcement from the next presidential administration, and on the other, the House just passed H.R. 2745, a bill that limits the Federal Trade Commission’s enforcement authority. The bill, which is opposed by Democrats and the White House, passed in the House 235-171, largely along party lines. House Republicans claim the bill addresses their concerns that a proposed merger is …
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California Regulators Approve Health Net/Centene Deal With Conditions
Elizabeth Nicholson, Research Fellow March 23, 2016
UPDATE: March 23, 2016: California state regulators approved the Centene and Health Net merger—subject to strong conditions. Centene announced that it received approval from the California Department of Managed Health Care (“DMHC”), on March 22, 2016, and approval from the California Department of Insurance (“CDI”), on March 23, 2016. Both state agencies placed significant—and expensive—conditions on the merger. DMHC provided an extensive list of undertakings. In addition to typical closing requirements, DMHC is requiring Centene to satisfy unique conditions. The San Francisco Business Times reported that DMHC’s conditions carry a “total …
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FTC Expresses Concerns About West VA’s Pro-Healthcare Merger Legislation
Anne Marie Helm, Managing Editor March 10, 2016
The FTC today expressed concerns about proposed legislation in West Virginia aimed at facilitating provider mergers in official written comments to the measure. The state’s legislation was drafted after the FTC challenged a West Virginia hospital merger in November, which we blogged about here. The FTC’s concerns are laid out in its press release, included below. In short, the FTC says it isn’t trying to prevent the good healthcare mergers, just the bad ones. March, 10, 2016 FTC Press Release: Federal Trade Commission staff submitted written comments on the competitive impact …
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Academic Articles & Reports Round-Up: February 2016
Elizabeth Nicholson, Research Fellow February 29, 2016
Although February’s literature was light in quantity, it was high in quality. The bulk of February’s articles and reports focused heavily on marketplace competition, healthcare consolidation, healthcare cost, pharmaceutical price reform initiatives, bundled payments, and high-deductible health plans. MARKETPLACE COMPETITION The Commonwealth Fund published an issue brief entitled Implementing the Affordable Care Act: Promoting Competition in the Individual Marketplace. In its brief, the Commonwealth Fund explores how the ACA has influenced individual healthcare marketplaces in Kansas, Nevada, Rhode Island, and Washington.[1] To understand the impact the ACA has had in …
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Source Advisory Board Member Greaney Weighs in on Big Insurance Mergers
Anne Marie Helm, Managing Editor February 25, 2016
Last month, in a letter to the U.S. Department of Justice (DOJ) Antitrust Division, the American Antitrust Institute described the competitive and consumer concerns surrounding the proposed health insurance mergers of Aetna-Humana and Anthem-Cigna. Source Advisory Board Member and AAI Advisor Tim Greaney co-authored the letter with AAI President Diana Moss. Professor Greaney testified before a House subcommittee last September on the dangers posed by the mergers, and submitted this prepared statement (as did Source Executive Editor Jaime King, who submitted this prepared statement). AAI’s letter argues, based on economic evidence, …
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Academic Articles & Reports Round-up: January 2016
Elizabeth Nicholson, Research Fellow February 1, 2016
As expected, a large number of articles and reports were published in January. Most heavily discussed was healthcare cost, which came up in many contexts, including: national spending slowdowns, comparatively among different countries’ healthcare systems, pharmaceutical drugs, healthcare services, the effect provider education has on cost, how cost intersects with quality, “cost-effectiveness,” and high-cost/high-need patient populations. Another hot topic was healthcare consolidation. One article discussed the general history and trajectory of healthcare consolidation (spoiler alert: it isn’t slowing down anytime soon) and the California Health Care Foundation published a mini-series …
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