On June 30, California Governor Gavin Newsom signed the 2022-2023 state budget, which includes a trailer bill (SB 184) that provides funding to establish the highly anticipated Office of Healthcare Affordability (OHCA) within the Department of Health Care Access and Information (HCAI). California joins a number of other states including Massachusetts, Oregon, and Rhode Island, as it becomes the latest state to establish a healthcare cost commission. This is a promising step forward in California’s efforts to control health care costs while ensuring high quality and broad accessibility. The main …

As federal agencies including the FTC and DOJ step up antitrust enforcement efforts in response to Biden’s executive order to revamp competition in the healthcare market, more and more healthcare entities are turning to less traditional consolidation that did not previously trigger antitrust scrutiny, such as “cross-market” mergers, which involve providers that do not directly compete in the same geographic market.[1] This month in Litigation and Enforcement Highlights, we take a look at the latest merger review and conditional approval of a proposed cross-market transaction in California, the third of …

This Blog provides supplementary comments on the recent Health Affairs article entitled “How Price Regulation Is Needed To Advance Market Competition” authored by Robert Berenson and Robert Murray.[1] The idea for the article was stimulated by conversations Bob Berenson and I have had in recent years regarding government administered pricing systems and market competition. Conventional U.S. health policy has asserted that these two approaches represent mutually exclusive strategies to address the issue of high and rapidly rising commercial health care prices. In our Health Affairs article, we attempt to refute …

This month’s Roundup highlights articles and reports discussing the need for improved, adequate monitoring of healthcare consolidation, including 1) vertical integration and joint contracting between physicians and hospital and 2) pharmaceutical mergers. We also examine articles studying healthcare cost affordability, specifically 3) the significant disparities in prices paid to hospitals by private plans and Medicare and 4) California’s improvements in healthcare affordability and access. Finally, we look at some proposed cost containment strategies such as 5) key areas to improve competition to reduce costs and 6) price caps on out-of-network …

Healthcare costs have grown exponentially in California[1], and Californians have indicated that it is a core issue they want the Governor and Legislature to address and remedy. In a 2021 poll, Californians expressed almost unanimous demand for action, as 82% of Californians said it is “extremely” or “very” important for the Governor and Legislature to make health care more affordable.[2] While rising healthcare costs seem to be a national problem, Californians pay more for common health services than the rest of the country, with an additional cost disparity between northern …

This month’s roundup focuses on articles and reports highlighting new research and insights relating to the high and rising costs of health care, which remain a major regulatory challenge for state and federal policymakers across the nation. First, we examine 1) research discussing potential strategies for price regulation and how it could support market competition, as well as 2) proposals for price growth caps via insurance rate review. Also highlighted in this month’s roundup are studies on healthcare costs, specifically 3) state-level trends in the overall cost of employer health …

Happy March! This month’s roundup focuses on health policy pieces and reports that examine 1) the future of value-based care, 2) the efficacy of various policy options to address healthcare prices, including increasing price transparency and market competition, 3) comparisons of brand-name drug prices, and 4) the impact of the Affordable Care Act on uninsured young adults.   Valued-Based Reform In a white paper published this past month, The Future of Value-Based Payment: A Road Map to 2030, researchers from the Leonard Davis Institute of Health Economics at the University …

The Source kicked off the New Year with a trio of blog posts in the Health Affairs Blog that highlights the Database of State Laws Impacting Healthcare Cost and Quality (SLIHCQ). The SLIHCQ Database was developed in partnership with the Catalyst for Payment Reform (“CPR”) and is an interactive tool that hosts ongoing state legislative efforts to implement healthcare reform. It is intuitively designed to allow policymakers and other stakeholders to customize and filter their searches by key issue and state. In collaboration with CPR, The Source Executive Editor Jaime …

In the 2020 legislative session, the California legislature enacted AB 2118 to require insurance companies selling insurance plans in the individual or small group market in California to file additional information, including premiums, cost sharing, benefits, enrollment, and trend factors, with the state Department of Managed Health Care (DMHC) or the California Department of Insurance (CDI).[1] This new law reflects an effort to give state agencies better oversight of state healthcare markets by patching small holes in the rate review process of state regulators. However, the time may be ripe …

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 …