Provider Network
[Case Watch] Commonwealth of Pennsylvania v. UPMC and Highmark: State AG Prevails with 10-Year Consent Decree After Long Bitter Court Battle
Amy Y. Gu, Managing Editor September 16, 2019
Pennsylvania’s efforts to restore competition to the provider and insurance markets in the long-standing battle between University of Pittsburgh Medical Center (UPMC) and Highmark Health overcame mounting challenges and finally concluded with an unprecedented 10-year consent decree. The Source closely tracked the case as it unfolded over the past several months. In this post, we take a look back at the case’s long and winding road, which included three stops at the Pennsylvania Supreme Court, leading up to the new truce. It’s Déjà Vu All Over Again It all began in …
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The Source Roundup: September 2019 Edition
Source Fellow September 3, 2019
By: Hayden Soria, Student Fellow Hello September! As we see cooler days slowly roll in, there are still many sizzling topics in this month’s health policy literature. In this Roundup, we take a dive into article and reports that discuss 1) the prevalence of surprise billing, 2) the effects of California’s AB 72 on provider networks, 3) increasing hospital prices, 4) hospital quality ratings, 4) increasing insurance premiums and out-of-pocket costs, and 5) health plan profitability. Surprise Billing and Provider Networks Eric C. Sun, Michelle Mello, and Jasmin Moshfegh explore …
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[Case Watch] UCFW & Employers Benefit Trust v. Sutter Health: Court Sets Antitrust Standards, Readying the Stage for Trial
Sammy Chang, Health Policy Researcher August 15, 2019
See UFCW & Employers Benefit Trust v. Sutter Health case page. Editor’s Note: As the historic antitrust lawsuit against healthcare giant Sutter Health heads to trial, The Source will feature a series of legal analyses, including revisiting the complaints and summary judgment order, to bring readers up to speed in this one of a kind case. The trial is set for September and expected to last around 12 weeks. Continue to follow The Source Blog as we bring the latest first-hand coverage and analysis in this case. On August 6, …
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The Source Roundup: August 2019 Edition
Source Fellow August 1, 2019
By: Hayden Soria, Student Fellow Happy August! Even as the summer winds down, there is no waning of health policy literature. In this month’s Source Roundup, we take a look at academic articles and studies that analyze 1) potential prescription drug savings from generics and biosimilars, 2) the need for price transparency, and 4) a multitude of efforts in health system reform. Potential Prescription Drug Savings from Generics and Biosimilars As prescription drug pricing continue to capture the nation’s attention, Stacie B. Dusetzina et al. take a dive into cost …
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States Are Taking the Helm on Antitrust Enforcement Efforts in Healthcare
Amy Y. Gu, Managing Editor April 15, 2019
State enforcement is the theme of the month in healthcare antitrust. A panel of antitrust experts at a recent Antitrust Symposium hosted by UC Hastings College of the Law discussed how exclusionary contracts and anticompetitive conduct by players in both the provider and pharmaceutical markets hinder competition and drive up healthcare prices. This edition of Litigation and Enforcement Highlights takes a look at current anticompetitive practices of providers and PBMs and the ensuing state regulatory efforts to address them. A Tale of Two Coasts in Provider Market Enforcement As …
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Who’s Driving Healthcare Prices: A Look at Anticompetitive Conduct of Various Players in the Healthcare Market
Source Fellow and Amy Y. Gu, Managing Editor April 9, 2019
By: Megan O’Leary, Student Fellow and Amy Y. Gu, Managing Editor On Thursday, April 4, The Source attended the “Antitrust in the New Millennium Symposium” hosted by UC Hastings College of the Law. This blog focuses on the session “New Antitrust and Healthcare”, moderated by The Source Board member and UC Hastings Professor Thomas Greaney, and featuring the panel of, notably all women, UC Hastings Professor Robin Feldman, California Senior Assistant Attorney General Kathleen Foote, and American Antitrust Institute (AAI) President Diana L. Moss. What drives rising healthcare prices? Perhaps it stems …
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AB 744 and Other 2019 Bills Seek to Increase and Improve Telehealth Delivery in California
Sammy Chang, Health Policy Researcher March 31, 2019
Avoid driving, get help instantly. That’s the premise of telehealth. Telehealth, under California law, is defined as “the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care.”[1] One study has shown that the use of telehealth, in California, has been found to save a patient 278 miles in driving, 4 hours in time, and $156 in direct travel costs per consultation.[2] As such, telehealth has been used as an …
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The Source Roundup: January 2019 Edition
Source Fellow January 2, 2019
By: Megan O’Leary, Student Fellow Happy New Year! We hope this year is filled with good health (policy) and much happiness! In this roundup, we look at (1) proposals to address healthcare costs and competition, (2) changes to section 1332 waivers, (3) rising healthcare costs, premiums, and deductibles, and three articles specifically about telehealth from a special Health Affairs issue. Proposals to Address Rising Healthcare Costs and Lack of Competition On December 3, the U.S. Department of Health and Human Services (HHS), in collaboration with the Departments of the …
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The Source Roundup: November 2018 Edition
Source Fellow November 1, 2018
By: Swaja Khanna, Student Fellow Happy November! We hope you are enjoying football season and preparing for turkey! In this edition of the Source Roundup, we cover five academic articles and reports from October. The topics this month include (1) the popularity of telemedicine for employers and employees, (2) an integrated health care system that combines ACO and bundled payment, (3) health spending growth in the coming years, (4) Maryland’s new initiative reduced hospital utilization and costs, and (5) how to remedy recent generic drug price hikes. Telemedicine Is …
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Surprise Balance Billing: The New Fight for Consumer Protection in Health Care
Source Fellow October 22, 2018
By: Leah S. Gray, Student Fellow A Texas high school teacher recently made headlines after getting a $108,951 bill when a heart attack sent him to an out-of-network hospital. The ambulance rushed Drew Calver to the nearest emergency center, which his insurance did not cover, leaving him with an astronomical surprise medical bill. Unfortunately, surprise medical bills are becoming a ubiquitous part of health care in America. The question is: why? Most people have insurance, but insurance doesn’t cover everything. So when Calver was treated at an out-of-network facility, his insurance …
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