HEALTHCARE MARKETS
Revolutionizing Medi-Cal: The Potential Impact of California’s CalAIM Initiative
Rachel Ng, Student Fellow March 15, 2023
California’s Medi-Cal program is the largest Medicaid program in the country. It is tasked with providing care for approximately 15 million enrollees, or one third of California’s population. To ensure affordability while maintaining quality and improving health care outcomes, CalAIM was created as California’s newest approach to reform Medi-Cal, including changes to managed care plans and reimbursement of behavioral health plans. Although many of these objectives under CalAIM are still in the initial implementation stages, the potential ramifications of this multi-year, billion-dollar investment in changing how millions of people receive …
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Healthcare Merger Watch Q1 2023: Nationwide Cross-Market Merger Mania
Amy Y. Gu, Managing Editor March 15, 2023
In this first healthcare merger watch of 2023, we highlight some consolidation activities from the first quarter in the healthcare industry. In a trend that has continued in recent years, healthcare entities in the latest proposed and pending deals are increasingly exploring consolidation in new and innovative ways, across different geographic regions and involving different healthcare players in the industry. Even though federal and state antitrust enforcers often successfully challenge traditional, horizontal mergers and acquisitions, transactions involving cross-market consolidation are typically not challenged due to less straightforward legal and economic …
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The Source Roundup: March 2023 Edition
Rachel Ng, Student Fellow March 1, 2023
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 …
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Governor Newsom’s Healthcare Budget Proposal for 2023-2024
Rachel Ng, Student Fellow February 15, 2023
On January 10, California Governor Gavin Newsom released his proposed budget of $296.9 billion in total state funds for the 2023-2024 fiscal year.[1] Even with the anticipated $22.5 billion shortfall in the budget and 7% decrease in last year’s implemented and revised budget, the Governor did not propose any cuts towards health care coverage for all Californians. The proposed budget sought to maintain Medi-Cal expansion, reduce prescription drug costs, and bolster mental and behavioral health services as key healthcare priorities for the state.[2] Health and Human Services expenditures were the …
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DOJ Withdraws Decades Old Guidance on Antitrust Enforcement in Health Care
Amy Y. Gu, Managing Editor February 15, 2023
Since the Biden administration’s release of the Executive Order on Promoting Competition in the American Economy in July 2021, federal enforcement agencies have visibly advanced their efforts to step up enforcement actions and continued to push forward new enforcement agenda. In the latest development, the Department of Justice (DOJ) announced on February 3 the withdrawal of three federal enforcement policy statements, which removes some of the safe harbor protections that were established for healthcare entity activities nearly three decades ago. DOJ’s action is a direct response to the executive order’s call for …
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Source Executive Editor to Appear on Connecticut CTNetworkTV to Discuss Healthcare Cost Drivers and Solutions
Amy Y. Gu, Managing Editor February 2, 2023
Updated: February 6, 2023 On Friday, February 3, Source Executive Editor Katie Gudiksen will speak at the Connecticut & U.S. Healthcare Cost Drivers Informational Session II regarding rate review and global budgets. This is an all-day event jointly hosted by the Connecticut Insurance Department, Office of Health Strategy, and Office of the Healthcare Advocate (OHA). It will be broadcast live on the Connecticut CTNetworkTV @9AM – 3PM EST on https://ct-n.com/ and recorded for future viewing. Updated 2/6: Recording is now available here. Katie’s presentation “Roadmap to Constrain Commercial Health Care …
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The Source Roundup: February 2023 Edition
Rachel Ng, Student Fellow February 1, 2023
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 …
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Major Insurers See Antitrust Enforcement Action Headed to Appeals
Amy Y. Gu, Managing Editor January 17, 2023
We ended 2022 with an update on trends in healthcare provider consolidation and enforcement actions. In this inaugural 2023 issue of Litigation and Enforcement Highlights, we turn to the latest action in healthcare payer enforcement and litigation. Major insurers UnitedHealth and Blue Cross Blue Shield experienced similar antitrust woes lately, as both insurers saw their seemingly finalized lawsuits headed to the appeals court. UnitedHealth Merger Challenge Continues Post-Acquisition The UnitedHealth and Change Healthcare merger lawsuit grabbed headlines at the end of last year. The deal was officially consummated in …
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Healthcare Consolidation Q4 2022: Cross-Market Mergers Continue Apace
Amy Y. Gu, Managing Editor December 15, 2022
2022 has been an active year in healthcare consolidation as well as for merger challenges and enforcement. As we approach the year end, healthcare deals continued as many entities seek to close the transactions before the new year. Increasingly, as seen in the 4th quarter, healthcare deals are shifting to cross-market transactions, making review and enforcement efforts more challenging. In case you missed it, this final Litigation and Enforcement Highlights of the year will help you catch up on some of the cross-market deals in Q4 2022 that caught our …
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Office of Health Care Affordability: California’s Healthcare Cost Commission Gears Up for Implementation
Rachel Ng, Student Fellow and Amy Y. Gu, Managing Editor December 14, 2022
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 …
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