Healthcare Cost Control State Health Care Cost Commissions: Their Priorities and How States’ Political Leanings, Commercial Hospital Prices, and Medicaid Spending Predict Their Establishment (The Milbank Quarterly) Brent D. Fulton, Daniel R. Arnold, Jordan M. Wolf, Richard M. Scheffler As healthcare costs continue to rise, states play an increasingly important role in addressing affordability and cost containment. In this Milbank Quarterly article, researchers examine the political and econ...| The Source on HealthCare Price and Competition
Rural Healthcare Access Rural Hospital Closures Led to Increased Prices at Nearby ‘Surviving’ Hospitals, 2012-22 (Health Affairs) Caitlin Carrol, Jessica Chang Research on how consolidation affects healthcare pricing largely centers on mergers rather than closures. Hospital closures, especially those in rural areas, reallocate patient populations to nearby ‘surviving’ hospitals posing distinct effects on the remaining healthcare market. In theory, reallocation of a patient population ...| The Source on HealthCare Price and Competition
Market Consolidation and Merger Review The Forgotten Anti-Monopoly Law: The Second Half of Clayton Act Section 7 (Texas Law Review) Robert H Lande, John M Newman, Rebecca Kelly Slaughter The authors of this article analyze the second prong of Section 7 of the Clayton Act, which prohibits mergers that “tend to create a monopoly.” In comparison to the well-known first prong that seeks to “substantially lessen competition,” the second prong is posited to wield more statutory power as it ...| The Source on HealthCare Price and Competition
The California State Legislature kicked off the first year of its 2025-2026 biennial Legislative Session on December 2, 2024. This year, the legislature got off to a sprinting start as it raced to meet the February 21, 2025 deadline to introduce new bills. Compared to last year, this year’s legislature proposed a wider swath of bills aimed at healthcare-related concerns, including enhanced merger review, the use of artificial intelligence (AI) in healthcare, and expanding access to both pro...| The Source on HealthCare Price and Competition
Department of Justice Looking Into United Health On February 21, 2025, the Wall Street Journal reported that the Department of Justice (DOJ) has launched a civil fraud investigation against UnitedHealth. The investigation is centered on Medicare billing practices, with sources saying that UnitedHealth-employed physicians were trained to document higher revenue-generating diagnoses, even if that was not what patients were being treated for. Additionally, the investigation is apparently loo...| The Source on HealthCare Price and Competition
On December 23, 2024, Aetna (part of CVS Health) filed a lawsuit against Radiology Partners and its private equity backers in the U.S. District Court for the Middle District of Florida – Jacksonville Division. The suit claims Radiology Partners, one of the nation’s largest imaging groups, manipulated the No Surprises Act (NSA) and its dispute resolution process to boost payments improperly. Aetna’s filing called this a “multiphase healthcare fraud scheme” that defrauded Aetna of...| The Source on HealthCare Price and Competition
Healthcare Pricing Can Public Option Plans Improve Affordability? Insights From Colorado (Health Affairs Forefront) Roslyn Murray, Christopher M. Whaley In the face of individuals and families unable to afford increasing insurance premiums due to lack of healthcare insurance competition, a variety of states are considering offering public option plans, commonly for ACA Exchange plans. These plans seek to provide coverage with low premiums by means of capped prices for those who do not meet Me...| The Source on HealthCare Price and Competition
In November of 2024, three lawsuits were filed by pharmaceutical manufacturers against the Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA), challenging how HRSA oversees the Federal 340B Drug Pricing Program. (HRSA is the sub-agency within HHS that administers the 340B Program). The potential impact of the lawsuits on the 340B Program is significant in its own right, but the outcome of the lawsuits could also have an indirect effect ...| The Source on HealthCare Price and Competition
Price Transparency Hospital Payment Caps Could Save State Employee Health Plans Millions While Keeping Hospital Operating Margins Healthy (Health Affairs) Roslyn C. Murray, Christopher M. Whaley, Erin C. Fuse Brown, Andrew M. Ryan As health insurance premiums continue to rise, state employee health plans are occupying an increasing portion of state budgets. State employers are often the largest purchaser or commercial health insurance in each state, given the volume of employees that they emp...| The Source on HealthCare Price and Competition
Healthcare Competition and Consolidation Chang(ing) Health Care: Bigger May Not Be Better, Just Necessary (Health Affairs Forefront) Atul Grover, Jonathan B. Jaffery As the health care market increasingly trends towards consolidation, many have been left wondering whether the trend towards amalgamated efficiency truly is better. The authors of a new Health Affairs article are arguing that the answer is no. Specifically, they state that the trend towards larger, more consolidated entities is r...| The Source on HealthCare Price and Competition
Healthcare Competition and Consolidation The Rise of Health Care Consolidation and What to Do About It (Health Affairs Forefront) Erin C. Fuse Brown, Yashawini Singh, Christopher M. Whaley, Jared Perkins As hospital consolidation continues to meteorically rise, an increasing number of government institutions including the Federal Trade Commission, the Department of Justice, and Congress, have diverted move resources towards understanding and responding to the negative impacts of these trends....| The Source on HealthCare Price and Competition
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...| The Source on HealthCare Price and Competition
Healthcare Competition and Consolidation Medicare Advantage and Consolidation’s New Frontier — The Danger of UnitedHealthcare for All (New England Journal of Medicine) Hayden Rooke-Ley, Soleil Shah, and Erin C. Fuse Brown This article describes the recent ransomware attack on Change Healthcare and the ownership structure of UnitedHealth Group, including how much market power it has with medical claims, data analytics, insurance, physicians, PBMs, pharmacies and a bank. The authors note ...| The Source on HealthCare Price and Competition
In late June Novant announced it would abandon attempts to buy two Community Health Systems (CHS) hospitals in North Carolina. This announcement followed a preliminary ruling in Federal District Court for Novant and a subsequent appellate court ruling for the Federal Trade Commission (FTC). Regardless of the final outcome of the merger, the preliminary Novant win is significant because it represents a successful use of the often cited, rarely successful, “failing firm” defense – which...| The Source on HealthCare Price and Competition
Mergers, Acquisitions and Healthcare Competition Is There Too Little Antitrust Enforcement in the U.S. Hospital Sector? (American Economic Association) Zarek Brot-Goldberg, Zack Cooper, Stuart Craig, Lev Klarnet From 2002 to 2020, there were more than 1,100 hospital mergers with a 1% enforcement rate by the FTC resulting in only 13 blocked transactions. The authors of this study speculate low rates of enforcement could be due to factors including budgetary issues and jurisprudence that favors...| The Source on HealthCare Price and Competition
On May 16, 2024, a Federal District Court Judge dismissed a case filed in 2022 by the Oregon Association of Hospitals and Health Systems (OAHHS, the trade group representing hospitals in Oregon) against the State of Oregon and the Oregon Health Authority (OHA). The suit challenged the law created by Oregon HB 2362, 2021 legislation that required health care entities that meet minimum thresholds to obtain state approval before any mergers or acquisitions. The new law created the Health Car...| The Source on HealthCare Price and Competition
Effects of Market Consolidation Cost, Quality, and Utilization After Hospital-Physician and Hospital-Post Acute Care Vertical Integration: A Systematic Review (Medical Care Research and Review) Alexandra Harris, Sarah Philbin, Brady Post, Neil Jordan, Molly Beestrum, Richard Epstein, Megan McHugh To determine the impact of vertical integration, the authors examine the associations between two types of integration, hospital-physician and hospital-Post Acute Care (PAC), and their effect on cost...| The Source on HealthCare Price and Competition
Healthcare Cost and Spending Promoting Value-Based Healthcare Decisions: A Case Study of Shared Savings Programs in New Hampshire and Maine (Pepperdine Policy Review) Christopher LaCreta and Lawson Mansell Shared savings programs (SSPs) are an emerging policy solution to combatting the rise of healthcare costs. SSPs enable patients to compare prices and receive incentives for saving money on some elective services. Researchers from Pepperdine University’s School of Public Policy recently pu...| The Source on HealthCare Price and Competition