UnitedHealth Group's insurance arm, UnitedHealthcare, pays its own Optum physician practices significantly higher rates than other providers in the same markets, driving up costs for consumers and employers while enriching itself. This practice highlights the conflicts of interest and anti-competitive effects of vertical integration in healthcare, raising calls for regulatory intervention.

Is Medicare Advantage improving healthcare efficiency or creating higher costs that favor insurers? Hayden Rooke-Ley explores its rapid expansion, questions about cost and care quality, and the challenges of implementing effective regulations.

This article outlines six key points about Oregon's regulatory review of the OHSU-Legacy merger. Hayden Rooke-Ley's critique of the OHSU-Legacy merger, emphasizing how OHSU's broad market definition may obscure significant anticompetitive risks, presenting a critical test for Oregon's Health Care Market Oversight program.

An increasing number of Medicare Advantage patients, especially those in their final year of life, are switching to traditional Medicare, leading to a significant cost shift from private insurers to taxpayers.

This article examines the Oregon Health Authority's comprehensive review of the proposed merger between OHSU and Legacy Health, highlighting key concerns about market concentration, potential cost increases, and the future of health care access and competition in the region.

This article explores a study led by Brown University researchers on the billions in potentially redundant payments Medicare Advantage plans receive for veterans primarily cared for by the VA, despite industry claims, like those from UnitedHealthcare, that these payments reflect actual costs.

This article examines lawsuits from Medicare Advantage insurers, who claim minor customer service issues threaten millions in bonuses, while experts like Brown University's David Meyers argue that these cases reveal deeper flaws in a rating system that overstates plan quality without accurately reflecting patient care.

The article exposes Ralph de la Torre's misuse of private equity-backed Steward Health for personal gain while highlighting the broader issue of private equity's damaging impact on healthcare, with legislative efforts for reform largely stymied by political and lobbying pressures.

This article explores how private equity firms have taken control of many U.S. emergency rooms, prioritizing profit by reducing physician hours, replacing doctors with less qualified staff, and inflating costs, resulting in compromised patient care and increased bills, despite regulatory efforts like the No Surprises Act.

As Medicare spending continues to rise, reaching 21 percent of total National Health Expenditures, policymakers are exploring site-neutral payment policies to mitigate costs without compromising care quality. This article examines the driving forces behind these policies, the bipartisan support they’ve garnered, and the challenges that lie ahead in implementing effective solutions.

This article explores the study done by Brown researchers on the imapct of Oregon's hospital payment cap and how other US states have an opportunity to implement similar control measures to achieve health savings.

CAHPR researchers examine the economic and healthcare implications of consolidation within the U.S. healthcare system while proposing legislative solutions aimed at curbing the adverse effects of consolidation.

The FTC's nationwide ban on non-compete agreements, originally set to take effect on September 4, 2024, is now entangled in legal battles that challenge the agency's authority. This article explores the ongoing debates, highlighting the loopholes in the current rule, and prescribes potential policy solutions.

A decade ago, CMS tried to rein in Medicare Advantage overbilling, only to withdraw amid industry pressure, now fueling a $2 billion fraud case against UnitedHealth. Newly released court documents expose the struggle to protect taxpayer dollars while navigating powerful industry pushback.

This article highlights a study published in JAMA Network Open that explores the impact of hospital-SNF (skilled nursing facility) integration on participation in alternative payment models (APMs), particularly focusing on the Bundled Payments for Care Improvement Advanced (BPCI-A) program. The findings reveal that while integration influences APM participation, the effects are complex, pointing to broader implications for healthcare systems.

The Medicare Physician Fee Schedule is a cornerstone of U.S. healthcare policy, directly influencing how services are priced and covered. This Health Affairs blog delves into a brief analysis of the CY25 Physician Fee Schedule Proposed Changes and what impact it could have moving forward.

Christopher Whaley testified before Congress, highlighting the urgent need of health care price transparency and its role in combating high healthcare costs in the US and enhancing policy decision-making.

This issue brief provides key lessons for other states interested in hospital payment caps. These include setting caps above Medicare rates but below typical state plan prices to maintain provider participation, exempting small and rural hospitals to protect vulnerable facilities, and legislating payment caps to ensure long-term stability. Oregon’s approach offers valuable insights for states seeking to control health care spending while ensuring access to care.

Dr. Ashish K. Jha, dean of the Brown University School of Public Health, addressed the House Committee on Ways and Means on why the U.S. is seeing a decline in private medical practices and what we can do about it.

Healthcare consolidation is fueled by the need for pricing power and financial stability under value-based care, but experts warn this trend threatens competition and transparency, calling for stronger oversight and legislative action.

The PE firm, Welsh, Carson, Anderson & Stowe has been released from the ongoing case against U.S. Anesthesia Partners, for monopolization in Texas. What does this mean for PE firms and antitrust scrutiny?

Is private equity good AND bad? Listen to experts including Dr. Yashaswini Singh talk about private equity with a nuanced approach.

State Treasurer Folwell's recent report with insights from Christopher Whaley unveils startling findings: North Carolina's 340B hospitals have been overcharging the state, shedding light on critical financial discrepancies in healthcare funding.

This article featuring Chris Whaley delves into whether the Valley Children's Hospital's actions align with its mission and the nonprofit ethos it claims to uphold.