Provider Network
The Source Roundup: June 2020 Edition
Kendall Kohlmeyer, Student Fellow June 1, 2020
The Source continues to extend wishes of safety and good health to you and your loved ones during this uniquely challenging time. Despite the reality that much of the healthcare industry suffers financial catastrophe due to the pandemic, experts note improvements in some areas. Authors this month expect some advancements to last and suggest how the U.S. should use them to diminish costs. Changes in Telehealth Will Likely Outlast the Pandemic In JAMA’s Implications for Telehealth in a Postpandemic Future, Carmel Shachar and co-authors affirm positive outcomes that the …
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The Crisis of COVID-19 Heightens the Need for Surprise Billing Protections
Katie Gudiksen, Senior Health Policy Researcher April 20, 2020
[Post Updated: April 20, 2020] Earlier this year, the federal government appeared poised to address the problem of surprise billing,[1] but the coronavirus pandemic shifted policy priorities before Congress had a chance to act. While some lawmakers may try to include surprise billing protections in the next COVID-19 stimulus package, the pandemic and its ripple effects make action by lawmakers to address surprise billing critical. Surprise bills, also known as balance bills, may occur when a patient unavoidably sees an out-of-network provider for an emergency situation or unexpectedly sees an …
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The Source Roundup: March 2020 Edition
Source Fellow March 1, 2020
By: Swaja Khanna, Student Fellow In this edition of the Source Roundup, we highlight articles and reports from February that discuss: (1) the prevalence of out-of-network billing during elective procedures with in-network services, (2) affordable care organizations’ potential to limit out-of-network spending, (3) findings from the new Health Care Cost and Utilization Report, (4) private health care spending growth varies by hospital referral regions, (5) U.S. has highest healthcare spending despite worst health outcome, and (6) how states policies encourage provider market competition and lower healthcare spending. The Prevalence …
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[Press Release] States Increasingly Turn to Legislation to Promote Competition and Control Health Care Prices, Per New Analysis from CPR and UC Hastings
Amy Y. Gu, Managing Editor February 25, 2020
SAN FRANCISCO, Calif. – February 25, 2020 – High commercial health care prices are a main driver of US health care spending, due in large part to consolidation among providers. While employers, other health care purchasers and payers can drive competition in the marketplace through benefit and provider network design, public policies can also strengthen and support those efforts. Catalyst for Payment Reform and The Source on Healthcare Price and Competition at UC Hastings College of the Law have catalogued state measures to enhance market competitiveness and control costs through legislation. The report, State Policies …
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[Sutter Case Watch] A Huge Deal: Settlement Terms of Sutter Health Antitrust Case Will Promote Transparency and Competition in California Provider Markets
Amy Y. Gu, Managing Editor January 15, 2020
See UFCW & Employers Benefit Trust v. Sutter Health case page. The high-profile antitrust case against Sutter Health settled on the eve of trial in October 2019, when the Northern California hospital giant reached a preliminary settlement agreement with the California Attorney General’s office and class action plaintiffs after five years of litigation. The terms of the settlement were released late December, which include both monetary compensation for the private plaintiffs and injunctions against Sutter’s conduct that will restore competition and promote transparency in the provider market. In this …
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The Source Roundup: January 2020 Edition
Source Fellow January 6, 2020
By: Swaja Khanna, Student Fellow Happy New Year! We hope you had an exciting start to the new decade! In this edition of the Source Roundup, we cover articles and reports from December that discuss: (1) increase in US health care spending in 2018, (2) health system affiliation and how it affects patient access, (3) out-of-network provider charges between 2012 and 2017, and (4) how billing in-network could save millions. U.S. Health Care Spending Increased 4.6 Percent to Reach $3.6 Trillion in 2018 In the Health Affairs article National …
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[Sutter Case Watch] BREAKING: Settlement Terms Released for Landmark Antitrust Case against Sutter Health
Sammy Chang, Health Policy Researcher December 20, 2019
See UFCW & Employers Benefit Trust v. Sutter Health case page. Today, California Attorney General Xavier Becerra announced the settlement terms for the landmark antitrust case, UFCW & Employers Benefit Trust v. Sutter Health. Sutter Health was alleged to engage in anticompetitive behavior by requiring “all or nothing” contracts, preventing insurance companies from providing tiered health plans, setting extremely high out-of-network rates, and restricting price transparency of provider cost information and rates. As Source Executive Editor Jaime King explains in a Tradeoffs episode, The Train Has Left the Station, …
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The Source Roundup: December 2019 Edition
Tiffany Wang, Student Fellow December 2, 2019
Happy December! The holiday season is upon us and it is time to cozy up with a warm cup of tea to the latest health policy news. This edition of the Source Roundup looks at articles on 1) healthcare market consolidation and provider network access, 2) increases in insurance premium contributions and deductibles, and 3) lessons from healthcare system reforms abroad. Healthcare Markets Accountable care organizations (ACOs) have been lauded for providing higher quality medical care at lower costs. In a recent Health Affairs research article, Changes in Physician Consolidation …
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[Case Watch] Jury Trial in Antitrust Case Against Sutter Health Set to Begin
Amy Y. Gu, Managing Editor October 9, 2019
See UFCW & Employers Benefit Trust v. Sutter Health case page. The landmark antitrust case against Sutter Health, the largest provider of general acute hospital services in Northern California, is set to begin jury trial in the Superior Court of San Francisco on October 10 and is expected to last 12 weeks. The trial will begin at 10:15am with opening arguments from both parties. The Source has been closely tracking this case leading up to the trial. Executive Editor Jaime King was quoted in multiple news outlets, including the New York …
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[Case Watch] UCFW & Employers Benefit Trust v. Sutter Health] A Look at the Legal Arguments Through the Lens of the Court’s Denial of Sutter’s Motions for Summary Judgment
Amy Y. Gu, Managing Editor October 7, 2019
See UFCW & Employers Benefit Trust v. Sutter Health case page. As part of the Case Watch series for the landmark antitrust suit against Sutter Health, this post takes a look back at the Superior Court of San Francisco’s orders from March and June 2019, denying Sutter’s motions for summary judgment, which set the stage for the jury trial, set to begin on Thursday, October 10, 2019. As a preview of the legal arguments we will see at trial, we dissect each of the four causes of action brought against Sutter …
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