States fight against provider consolidation

As providers continue to team up, insurers claim the growing rate of provider consolidation leads to high healthcare costs. Many states want to lessen the impact of provider consolidation by implementing laws and regulations that encourage price disclosure and ensure limits on healthcare prices, according to a new paper from the National Academy of Social Insurance and Catalyst for Payment Reform.

Listed below are four states considered the most active with regards to limiting provider consolidation, enhancing the competitiveness of their healthcare markets and reducing providers' power, according to the report.

California: The California Department of Justice continues to investigate whether mergers and acquisitions have allowed health systems to raise prices--the state Office of the Attorney General also monitors hospitals for potential antitrust violations. What's more, the state is looking at ways to limit providers' ability to disclose price information.

Massachusetts: The state established the Health Policy Commission (HPC) to monitor healthcare payment and reform. Specifically, the HPC reviews changes issued by provider networks, while also focusing on changes occurring within the state's healthcare market.

New Hampshire: The New Hampshire Insurance Department (NHID) not only reviews rates, but also provides rate transparency to consumers. Additionally, the NHID is looking into the relationship between public payer hospital reimbursement and costs paid by commercial insurance companies.

Rhode Island: The state's Department of Insurance is working to ensure it has the ability to review rates. Rhode Island established the Office of the Health Insurance Commissioner in 2004 with the intent to protect consumers, ensure fair treatment of medical service providers and improve the overall quality of the healthcare system.

To minimize provider consolidation's effect on rising healthcare costs, insurers can consider using provider price and quality tools, narrow provider networks and reference pricing.

For more:
- here's the full report (.pdf)

Suggested Articles

Welcome news to many health IT stakeholders: HHS announced Friday that it is extending the comment period for two proposed interoperability rules.

CMS took aim at increasing the use of generic drugs in ACA plans in a new rule filed Thursday evening.

Fidelity and the NBGH found large employers are expected to spend an average of $3.6 million this year on wellness programs.