The FTC has issued 6 health insurance companies to provide claims data from 2015 through 2020 for a merger retrospective program. With the new mandate to disclose payer-negotiated rates, analysis may shed light on the effects of physician group and healthcare facility consolidation. In a public letter, Richard Scheffler and other economists commented on vertical merger guidelines.
Richard Scheffler has experience in studying how premiums and outpatient prices spiked as California health systems have incrementally acquired physician groups.
Link to article here.
Link to FTC request here.
Richard Scheffler and other experts in the health care system published “How the Biden Administration Can Make a Public Option Work” in Harvard Business Review. This article argues for the termed Better Care Plan in which Biden-Harris’s public option proposal operates under The Medicare Advantage model with capitated payments. Insurers participating in public option would be in competition when annually required to provide transparent and uniform cost, utilization, quality, and patient experience data to the public.
Richard Scheffler worked with colleagues to publish an article titled “Better Care Plan: A Public Option Choice” in Health Affairs on November 16, 2020. This recommends that the Biden-Harris health care proposal not be operated under fee-for-service like traditional Medicare.
If the public option were to be operated under pre-determined risk-adjusted capitation payments to teams of providers, health professionals would be incentivized to provide evidence-based care. In addition, payments made per-member-per-month would provide a predictable revenue stream–which is particularly important as COVID-19 threatens providers’ financial stability.
All authors: George C. Halvorson Stephen M. Shortell Laurence Kotlikoff Elizabeth Mitchell Richard M. Scheffler John Toussaint Peter A. Wadsworth Gail R. Wilensky
On October 22, 2020, Richard Scheffler was named an editorial advisory board member of The Milbank Quarterly, a quarterly peer-reviewed healthcare journal covering healthcare policy. Their publications connect empirical research to practical policymaking. The 38 scholars on the board collectively offer multidisciplinary insight into social, economic, political, historical, legal, and ethical aspects of health and healthcare policy.
The Petris Center article, “What Does Senator Kamala Harris’ Record As California’s Attorney General Tell Us About Her Health Policy?” was cited in The New York Times on October 6, 2020. This analysis delves into her history in health policy as attorney general in three areas: antitrust (especially mergers and consolidation), pharmaceuticals, and support of the Affordable Care Act (ACA). Richard Scheffler was quoted in The New York Times on Harris prioritizing health care as an attorney general.
Read the full New York Times article here.
Read the full Petris Center article here.
On Thursday, September 10, Professor Richard Scheffler served on an online panel discussing the topic: Antitrust Implications of Healthcare Provider Consolidation. Hosted by the California Lawyers Association, the webinar discussed antitrust issues that result from vertical integration, the impact of the COVID-19 pandemic on antitrust and economic analysis, and the ongoing Sutter case. The two other panelists were Laura Alexander (VP of Policy at the American Antitrust Institute) and Michelle Lowery (Partner at McDermott Will & Emery).
Healthy California for All Commission released a report, “An Environmental Analysis of Health Care Delivery, Coverage, and Financing in California” for California Governor Gavin Newsom, Senator Richard Pan, and California State Assemblymember Jim Wood. It examines the strengths and limitations of California’s current health care system, outlines potential designs to transition to unified financing, and describes health coverage expansion options.
In its analysis of provider consolidation, The Petris Center’s study “The Sky’s the Limit” is cited for trends of hospital market concentration. “A New Vision for California’s Healthcare system” is cited in discussing cost containment strategies, and “California Dreamin’: Integrating Health Care, Containing Costs, and Financing Universal” explores the role of integrated plans.
This research report titled “Preventing Anticompetitive Contracting Practices in Healthcare Markets” analyzes five specific clauses in healthcare contracts that have the potential for anticompetitive harm. In understanding the theory and empirics of pro- and anti-competitive effects in specific healthcare markets, we reviewed legal and economic literature, examined antitrust enforcement of contract terms, and surveyed all 50 states of proposed and enacted legislation restricting the use of these contract clauses. This report is the latest product from a joint project with The Petris Center and The Source on Healthcare Price and Competition supported by Arnold Ventures.
This project leverages the latest and most comprehensive data on state laws, healthcare markets, and healthcare prices in provider and insurer markets in the United States in the last ten years and presents evidence-based information and analyses on the most effective strategies for states to address rapidly consolidating healthcare markets. In the first published report in the series, “Preventing Anticompetitive Healthcare Consolidation: Lessons from Five States” identifies best practices that state policymakers should consider to enhance oversight of healthcare consolidation in their own state.
Additional research findings and analyses are published on the “Provider Contracts” and “Market Consolidation” key issue pages.
The Petris Center study, “The Distribution of Provider Relief Payments Among California Health Systems” was cited in The New York Times on July 10, 2020. The analysis estimated that a 24% reduction in net patient revenue was offset by direct CARES Act grants and varied widely by hospital. Hospitals with a larger share of net patient revenue from private insurers and hospitals residing in highly concentrated hospital markets received larger payments per adjusted patient day.
Read the full article here.
Read the full study here.
On June 25, 2020, a Petris Center study titled “What are the Health Care Costs of COVID-19 in California?: State and County Estimates” was cited in the San Francisco Chronicle. The study estimates the total cost of COVID-19 at a 5% prevalence in the state at $2.4 billion. The article focuses on the high costs in the Bay Area due to higher commercial prices in this part of the state.
Read the full article here.
Read the study here.