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 post, we dissect the terms of the proposed settlement agreement and discuss …

On January 10, California Governor Gavin Newsom released his 2020-2021 State Budget proposal. While the state budget process will not begin in earnest until after the Governor’s May Revise, the state budget provides a glimpse of likely California health care reforms. The Governor’s January Budget Proposal proposes the following: Proposal Goals Office of Health Care Affordability Increase price and quality transparency Develop cost targets for health care industry Address hospital cost trends by region, with focus on cost increases driven by delivery system consolidation Establish standards for advance evidence-based and …

Price transparency in healthcare is a hot topic that has captured the attention of many policymakers. While both federal and state governments have made efforts to promote price transparency in recent years, the path to achieving it is expected to be a bumpy one, as powerful industry groups that resist such change, including hospitals and pharmaceutical companies, are quick to seek legal challenges to block such efforts. In this edition of Litigation and Enforcement Highlights, we examine the latest lawsuits that challenge legislation to promote price transparency in healthcare and …

The autumnal season is upon us!  This month, we pull no tricks, and treat you to a review of articles and reports about 1) the impact of healthcare market concentration, 2) the potential use for price transparency, and 3) government efforts to influence pharmaceutical pricing.   Conflicting Views on How Market Concentration Impacts Healthcare Prices Two recent reports point to an increase in healthcare market concentration and discuss the effects on price and competition.  The American Medical Association (AMA) just published the 2019 edition of the annual study of market …

Updated 10/14/2019: Governor Newsom has signed AB 651, which will take effect January 1, 2020.   There are few bills in the 2019 California Legislative cycle more supported by the Legislature than AB 651, which would reauthorize the Emergency Medical Air Transportation Act (“Act”) and prohibit balance billing by air ambulances. To fully understand the impact and significance of AB 651, we will first examine the history and evolution of the Emergency Medical Air Transportation Act, starting in 2010, to better appreciate the original intent of the Act. Second, we …

The lawsuit alleging anticompetitive conduct by Sutter Health is scheduled to begin trial on October 7, 2019 in the Superior Court of San Francisco. In the case, California Attorney General and private parties United Food and Commercial Workers union (UFCW) and Employers Benefit Trust (UEBT) allege that Sutter Health used its position as a dominant provider of hospital services in Northern California to demand anticompetitive contract terms from insurance carriers.[1],[2] Since the factual allegations and legal claims made in both the AG and private complaints are similar, the court consolidated the cases …

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 …

Hot off the press: Health Affairs Blog post The State Of State Legislation Addressing Health Care Costs And Quality highlights The State Laws Impacting Healthcare Cost (SLIHCQ) Database established by The Source on Healthcare Price and Competition and Catalyst for Payment Reform (CPR). The Source Executive Editor Jaime King and CPR Director Suzanne Delbanco discuss key approaches states are taking to develop high-quality, affordable health care, including transparency laws, payment reform and benefit design laws, laws that encourage provider competition, and laws that govern oversight and regulation of costs. Check …

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 …

Many health care providers and payers seek to maintain the confidentiality of amounts paid for services as trade secrets, claiming their secrecy provides a competitive advantage. With support from the California Health Care Foundation (CHCF), The Source’s Katie Gudiksen, Sammy Chang, and Jaime King examine the legal and economic implications of collecting and releasing this data in the newly published report, The Secret of Health Care Prices: Why Transparency Is in the Public Interest.  Part I of this report reviews trade secret statutes and case law regarding the protection of negotiated …