Healthcare Competition and Consolidation Vertical Integration and Market Consolidation in Healthcare: Policy Drivers and Impact on Physicians and Patient Care (Seminars in Colon and Rectal Surgery) Rachel Ekaireb, Anna Yap, and Robert Kucejko Over the past several decades, the healthcare market has become increasingly consolidated. For instance, in the last twelve years alone, the percentage of physicians employed by hospitals or healthcare systems has more than doubled from 26% to 55%. While proponents for vertical integration have touted its potential to improve the efficiency and quality of care delivery, empirical …

In the last issue of California Legislative Beat, we examined some significant bills from year one of California’s 2023-2024 legislative term. Specifically, we focused on legislation that sought to make changes in healthcare competition, consolidation, and system reform. In part 2 of the 2023 session recap, we turn our attention to bills that aimed to tackle healthcare service and pharmaceutical costs, coverage, and price transparency.   Healthcare Costs and Coverage Californians can expect to be protected from surprising dental or emergency ground medical transportation bills soon. The legislature approved and …

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 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 …

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 …

Fall is upon us, and the time is better than ever to sip on a cup of tea (or coffee) and catch up on some of the latest articles and reports! In this month’s Source Roundup, we cover a variety of topics in healthcare price and competition. First, we shine the spotlight on the rise in private equity acquisitions, particularly of physician practices and ambulatory surgical centers, and highlight some of the latest studies that examine the implications of these acquisitions on healthcare cost and spending, utilization, and quality. Second, …