The American Antitrust Institute (AAI), in collaboration with the University of California at Berkeley (UCB) Petris Center on Health Care Markets and Consumer Welfare, and the Washington Center for Equitable Growth (Equitable Growth), announced the release of a new report on private equity ownership in healthcare.
Lead author on the report, Professor Richard Scheffler, Distinguished Professor of Health Economics and Public Policy, and Director of the Petris Center at UCB, noted “This report provides convincing evidence that incentives to put profits before patients have grown stronger with an increase in private equity ownership of physician practices. This will fundamentally change the way medicine is practiced.”
Read the full American Antitrust Institute report here.
Listen to the Personal Equity Report Cited in House Oversight Committee Hearing here.
By Stephen M Shortell, John S Toussaint, George C Halvorson, Jon M Kingsdale, Richard M Scheffler, Allyson Y Schwartz, Peter A Wadsworth, Gail Wilensky | Published June 20, 2023 in Health Affairs Scholar | Link to Full Article
The United States falls far short of its potential for delivering care that is effective, efficient, safe, timely, patient-centered, and equitable. We put forward the Better Care Plan, an overarching blueprint to address the flaws in our current system. The plan calls for continuously improving care, moving all payers to risk-adjusted prospective payment, and creating national entities for collecting, analyzing, and reporting patient safety and quality-of-care outcomes data. A number of recommendations are made to achieve these goals.
Spearheaded by Richard Scheffler, Distinguished Professor Emeritus, and Stephen Shortell, Distinguished Professor Emeritus and Dean Emeritus, the research team carried out their vision of going from pen to policy. The team shared findings about a potential public option plan for the state with state legislators, stakeholders, and press. This plan would lower healthcare costs while maintaining quality for Californians. With a prominent discussion panel moderated by the Deputy Cabinet Secretary and featuring various healthcare pioneers, insightful questions were answered, swaying doubts were quelled, and productive ideas were exchanged.
“Two emeritus professors at UC Berkeley School of Public Health have proposed a California public option health insurance plan called Golden Choice that could save more than $243 million in its first year and lower insurance premiums throughout the state marketplace.”
“We are health law and antitrust, health services research, and health economics researchers specializing in health law and policy issues. We have studied private equity and other corporate investment in physician practices and examined the effects on patient care, workforce composition, market consolidation, and costs. Our comments focus on the application of the Non-Compete Rule to physicians and other health care professionals.”
By Richard M. Scheffler, Ola Abdelhadi | Published April 21, 2023 in Oxford Academic | Link to Full Article
Older Americans have unique health needs that require specialized care and support. As people age, they are more likely to develop multiple chronic conditions such as cancer, diabetes, heart disease, and arthritis, which can greatly affect their quality of life (Boyd et al., 2019). Additionally, older adults may also experience physical and cognitive declines, which can make it difficult for them to manage their own healthcare. Access to healthcare and supportive services is crucial for older Americans to maintain their health and independence. Services such as home healthcare, nursing homes, and hospice care play a vital role in helping older adults lead fulfilling lives and maintain their quality of life for as long as possible. The majority of hospice patients are diagnosed with one or more chronic conditions, with cancer being the most common (29.6%), followed by circulatory or heart disease (17.4%) and dementia (15.6%) (Hospice Facts & Figures, 2020). Meanwhile, as the American population of persons aged 65 years and over will soon outnumber those under 18 year of age, there are concerns about the quality of care for older Americans as the healthcare industry shifts towards private equity (PE) ownership (Braun, Stevenson, et al., 2021).
By Arjun Teotia, Daniel R. Arnold, Richard M. Scheffler | Published April 21, 2023 in JAMA Health Network | Link to Full Article
Is a low-cost, county-based public insurance option associated with slower premium growth on the California Affordable Care Act exchange?
On Covered California (CC), the state-run Affordable Care Act (ACA) exchange in California, gross annual premiums for members have increased by 41% since CC started in 2014 ($9612 in 2022 vs $6804 in 2014).1 Through CC, individuals and their families can purchase private health insurance plans. Exchange coverage is generally intended for those who do not have access to health insurance through their employer, Medicare, or Medicaid. Nearly 90% of CC enrollees receive subsidized coverage in the form of reduced (often 0) premiums and reduced cost sharing.1 California is one of the few states that uses an active purchaser model for its exchange, which allows it to standardize benefits and cost sharing, selectively contract with insurers, and negotiate premiums.2 Premiums and insurers vary across the 19 regions of CC. Los Angeles (LA) has some of the lowest premiums and premium growth rates on CC. It is also the only region with a public plan—LA Care—which competes with 6 private insurers on the exchange.
Our work extends this research and is the first known study to empirically evaluate how a county-based public option performs in the ACA Marketplace in California. Specifically, we statistically evaluated whether LA Care was associated with reduced premium growth in LA compared with premium growth in other regions of CC.
By Richard M. Scheffler, Stephen M. Shortell | Published April 21, 2023 in The Commonwealth Fund | Link to Full Article
A public option is a government-established health insurance plan designed to inject more competition into the market and improve coverage affordability over time. Despite widespread support, little progress has been made at the federal or state level toward creating such a plan. We propose a public option plan for California, Golden Choice, that would be based on the state’s “delegated model” of health care under which provider organizations accept the financial risk for delivering health care services.
Even though a “public option” health plan has support from the Biden administration as well as the majority of voters, little progress has been made in creating one at the federal level.1 At the state and county levels, public options — simply, health insurance plans established by governmental entities — have been introduced to increase competition in the insurance market and improve affordability of health coverage over time. Governmental authorities can either directly administer these plans or establish a public–private partnership whereby the state sets requirements for private health plans to offer coverage.
Absent federal action, several states like Washington, Colorado, Nevada, and Minnesota have developed their own public option plans, with many other states in the process of developing plans.2 These plans rely on price caps or regulations, such as a requirement that insurers offer a public option plan to participate in Medicaid.3 To date, however, they have had little success in attracting enrollment or increasing competition among insurers to lower premiums.4
We propose a different type of public option plan for California. It would be based on the state’s “delegated model” of health care: provider organizations accept the financial risk of delivering health services, and their earnings are linked to their ability to keep patient care costs within a budget. Below we describe this new approach to a public option, which we call Golden Choice, and evaluate its potential impact on consumers’ health insurance premiums.