Provider Network
Class Action Antitrust Suit Claims University of Pittsburgh Medical Center Used Monopsony Market Power to Suppress Healthcare Workforce Conditions
Bruce Allain, Managing Editor February 15, 2024
On January 18, 2024, Victoria Ross, a former University of Pittsburgh Medical Center (UPMC) nurse, filed an antitrust class action suit in the US District Court for the Western District of Pennsylvania against UPMC. The suit claims UPMC used its “monopsony power to prevent workers from exiting or improving their working conditions, to suppress workers’ wages and benefits, and to drastically increase their workloads, through a draconian system of mobility restrictions and widespread labor law violations that lock employees into sub-competitive pay and working conditions.” Parties to the Suit According […]
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The Source Roundup: December 2023 Edition
Bruce Allain, Managing Editor December 1, 2023
Healthcare Prices and Cost In An Era Of Premium And Provider Price Increases, State Employee Health Plans Target Key Cost Drivers (Health Affairs Forefront) Sabrina Corlette, Karen Davenport Employer-sponsored health insurance premiums have outpaced inflation and are poised for significant rate hikes this year. State Employee Health Plans have been in a prime position to address health care costs. Administrators of these plans identified reference pricing, tiered network plans, and multi-payer purchasing initiatives as having promising results in addressing cost drivers. The Joint Distribution Of High Out-Of-Pocket Burdens, Medical Debt, […]
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The Source Roundup: May 2023 Edition
Rachel Ng, Student Fellow May 1, 2023
As we prepare to transition to the summer, this month is an opportune time to examine the impacts of potentially a new season in the health care market. Researchers noted that not only is there a rise of geographically distant mergers even as rural hospitals struggle to maintain profitability, but also that private equity is a new major financier of the health care market. On the other hand, California hopes to increase competition with Golden Choice, a state-run public option. Federally, price transparency efforts could be a step towards creating […]
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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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The Source Roundup: December 2022 Edition
Rachel Ng, Student Fellow December 1, 2022
As the end of the year approaches, there’s no better time to catch up and reflect upon new research and findings from the past year. The articles and reports in this month’s Roundup examine the latest trends in consolidation including (1) the rise of cross-market hospital systems and (2) concentration in the insurance markets. We also highlight articles that explored (3) the current state and future of telehealth regulation and (4) quality impact for hospitals that switch to a value based payment model. Consolidation and Competition Although 2022 has […]
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Recapping the 2022 California Legislative Session: What Was and What Wasn’t – Part 2: Promoting Telehealth and Tackling Out-of-Network Costs and Prescription Drug Prices
Amy Y. Gu, Managing Editor November 13, 2022
In the previous issue of the California Legislative Beat, we recapped noteworthy bills from year two of California’s 2021-2022 legislative term, specifically legislation that sought to regulate healthcare competition and ensure affordable access (see Recapping the 2022 California Legislative Session – Part 1). In this second part of the two-part series, we turn to bills that aimed to eliminate surprise out-of-network costs, advance telehealth, and rein in prescription drug prices, including ones that were signed into law and some important ones that didn’t make the cut. Surprise Out-of-Network Costs […]
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The Source Roundup: March 2022 Edition
Hannah Park, Student Fellow March 1, 2022
This month’s Roundup includes articles on healthcare merger review, specifically new policy recommendations that explain 1) why regressing price on the HHI does not inform merger analysis, and 2) how courts can implement health equity concerns in merger review. Next, we examine articles that evaluate potential strategies to reduce healthcare costs, including 3) state initiatives that build on past improvement efforts, and 4) financial incentives to reward patients for choosing lower-priced providers. Finally, we look at 5) trends in outpatient telehealth use since the start of the pandemic, and 6) […]
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The Source Roundup: January 2022 Edition
Hannah Park, Student Fellow January 3, 2022
Happy New Year! In this inaugural issue of 2022, we roundup articles and reports that you may have missed from the year end that examine various healthcare price and competition issues, including 1) an observational study on states’ merger review powers and their effect and 2) a review of policy options for addressing the extent and impact of consolidation in California. In addition, we cover articles that examine 3) the correlation between prices disclosed under the new hospital price regulation with total costs of care among commercially insured individuals, 4) […]
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What’s Ahead for 2022: Promising Healthcare Bills Pending in the California Legislature
Enne Mae Guerrero, Graduate Research Fellow December 13, 2021
The California legislature has passed nearly 800 bills in the 2021 session. As part of the two-year term, the legislature still has the opportunity to enact more meaningful healthcare legislation in the second year of the 2021-2022 legislative term. In the last issue of the California Legislative Beat, we recapped the 2021 legislative session and detailed the enacted and vetoed bills that enhance healthcare delivery, ensure healthcare access and coverage, promote price transparency, and reinforce competition and enforcement. In this post, we summarize some of the key pending legislation in […]
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Recapping the 2021 Session: Healthcare Legislation Passed in California
Enne Mae Guerrero, Graduate Research Fellow November 14, 2021
In the 2021 legislative session, California’s democratic-held legislature has passed roughly 800 bills, 770 of which have been enacted after approval by Governor Newsom.[1] A number of bills impacting the healthcare industry passed overwhelmingly in both houses, yet a couple of critical bills were vetoed. Notably, the COVID-19 pandemic, which shifted legislative focus away from healthcare costs in 2020, has amplified the various pitfalls of the healthcare system. This session, the legislature returned to propose several bills to mitigate these shortcomings and address healthcare costs and access. This post summarizes […]
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