Consolidation and Competition A Doctrine in Name Only — Strengthening Prohibitions against the Corporate Practice of Medicine (NEJM) Jane M. Zhu, Hayden Rooke-Ley, and Erin Fuse Brown The NEJM perspective examines state corporate practice of medicine laws that prevent ownership or control of physician practices by corporate entities. In an accompanying audio interview, Erin Fuse Brown discusses the role of these laws, including the usefulness and how they could be strengthened. Competition in Commercial PBM Markets and Vertical Integration of Health Insurers with PBMs: 2023 Update (American Medical Association) José R. …

In the past month, newly released publications have chronicled how partnerships, alternative payment models, and insurer market power affect competition and consolidation. Separately, researchers examined Affordable Care Act developments in terms of its impact on coverage and costs of health care. Moreover, as more and more price data are made publicly available, researchers studied how that data is presented, utilized, and what is reveals.   Competition and Consolidation Since 2005, over 190 rural hospitals have closed across the US, and today, 600 more (the nearly one third that remain) are …

In the previous issue of the California Legislative Beat, we examined healthcare bills introduced in the 2023-2024 legislative term that target healthcare consolidation and competition in California (see 2023 California Healthcare Bills – Part 1). In this second part of the two-part series, we explore some newly proposed bills that seek to increase access to care, control costs, and improve transparency in data and prices.   System Reform and Access California is a leader in innovative healthcare policy and initiatives, particularly to increase patients access to care while lowering overall …

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 …

With the healthcare market at the most consolidated it has ever been, both federal and state action is needed to ensure health care systems provide high-quality, affordable care that is accessible. In this month’s roundup, we begin with several publications authored by The Source team on the ramifications of consolidation and the role of federal and state antitrust enforcers. Researchers also considered whether health care providers and insurers have returned to pre-pandemic performance levels. With the rise of health care spending and health care costs, understanding these trends becomes especially …

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 …

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 …

Happy New Year, Source Readers! We kick off 2023 with highlights of some reports and articles that you may have missed from December. In surprise billing protection efforts, the implementation of the No Surprises Act is hitting unexpected backlogs in the IDR process, while the loophole of ground ambulance surprise bills also warrants further policy attention. Reports on healthcare spending and out-of-pocket costs suggest that healthcare is becoming less affordable as out-of-pocket costs continued to rise. Lastly, a pair of studies on value-based payment models reveal flaws in the systems …

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 …

In this month’s Roundup, we highlight some noteworthy articles and reports that discuss 1) state options for provider rate regulation and their potential pitfalls such as regulatory failure and regulatory capture; 2) consolidation trends in the hospital market and pharmaceutical industry; 3) price transparency efforts including compliance with the hospital and insurer transparency rules and the state-federal partnership to implement the No Surprises Act; and 4) drivers of national health spending.   Provider Rate Regulation With the rapid consolidation of health care providers and highly concentrated insurance markets, consumer bargaining …