by Shaanth Nanguneri

By Casey Ross and Tara Bannow

By Kristine de Leon

"New state laws tackle the burden of medical debt and the corporate take-over of medicine."

by Kimberly Marselas

Meaningful opportunities to reduce U.S. health-care costs already exist but are often overshadowed by the focus on more politically prominent proposals.

Interview by Rob Lott

By Mario Aguilar

The article explains how growing consolidation among insurers, hospitals, and physician groups is driving higher prices and fewer choices for patients, while current antitrust tools struggle to keep up with these increasingly complex mergers.

While Medicare Advantage offers many advantages, it also has drawbacks that should be considered

Researchers found UnitedHealthcare paid 17% more to Optum than to other providers.

Researchers said the results suggest UnitedHealth may be sidestepping government rules meant to keep a lid on exorbitant payer profits.

The trend toward investor ownership is part of a broader national shift in health-care consolidation, said Hayden Rooke-Ley, a senior fellow at Brown University’s School of Public Health. Over the last decade, large non-hospital retailers such as Amazon and Walgreens, along with insurance conglomerates, have restructured to own or manage medical practices, drug distributors and wholesalers.

Heard on All Things Considered
By Bram Sable-Smith

By Christopher Snowbeck

This article quotes Brown University researchers Chris Whaley and Roslyn Murray from the CAHPR, who explain that wide hospital price differences across Rhode Island stem less from care quality and more from market consolidation. Whaley noted that “there’s really not a strong relationship between price and quality,” while Murray pointed to “empire-building tactics” and consolidation that give large health systems leverage to raise prices and obscure transparency

On October 6, 2025, California Governor Gavin Newsom signed SB 351, aimed at limiting the involvement of private equity groups and hedge funds in health care practices.

This article discusses a Brown University study showing that commercial insurers pay nearly $1,500 more per procedure at hospital outpatient departments than at ambulatory surgical centers. The findings highlight large price variations across insurers and suggest opportunities for cost savings through selective contracting or site-neutral payment reforms.

Hospitals are discouraging infection testing to avoid Medicare penalties, a practice clinicians say jeopardizes patient safety and skews public reporting. As Brown University’s Andrew Ryan put it, “Basically, the measures are just really, really bad … this is honestly the worst” pay-for-performance program, underscoring deep flaws in how infection penalties are designed and enforced.

UnitedHealth’s Medicare Advantage program has come under scrutiny for allegedly exploiting diagnostic “upcoding” practices that drive billions in excess federal payments. Brown University researchers have launched Medicoding.org, a public tool that tracks how diagnostic coding in Medicare Advantage inflates payments to insurers. Health economist David Meyers explains that while some coding reflects real patient needs, much of the increase stems from insurers “gaming the system,” making beneficiaries appear sicker than they are

Republican lawmakers pressed for stricter oversight of nonprofit hospitals at a House hearing, arguing that many exploit tax exemptions while providing limited charity care. Witnesses, including Brown University’s Christopher Whaley, highlighted that current reporting structures obscure hospital-level community benefit, and urged stronger, more transparent requirements to ensure accountability.

In testimony before Congress, Brown University researcher Christopher Whaley revealed that many nonprofit hospitals reap massive financial benefits yet spend far less on community health than their tax exemptions are worth. With bipartisan concern mounting, Whaley urged reforms to ensure tax breaks translate into affordable, high-quality care for patients — not executive perks or stadium sponsorships.

This article reports on a Health Affairs study led by Brown University researchers analyzed over a decade of private equity acquisitions in opioid treatment programs across 43 states. The findings show that despite rapid growth in private equity ownership, there were no measurable improvements in methadone access, treatment expansion, or opioid-related mortality

A new Health Affairs study reveals that hundreds of urban hospitals have secured “Medicare administratively rural” status—unlocking benefits meant for rural communities. While CMS prepares to roll out its $50 billion Rural Health Transformation Program, the findings raise concerns about loopholes, misaligned incentives, and whether subsidizing facilities truly improves access for rural patients.

This article talks about a Health Affairs study led by researchers at CAHPR, University of Pittsburgh and the RAND Corporation on the current PE ownership of opioid treatment programs in the US. Despite acquiring large shares of the market, PE firms are not expanding access to methadone—leaving the treatment gap largely unchanged.

In the first half of 2025, states enacted numerous laws to strengthen their health care markets. These new laws address several recurring policy issues affecting states across the country, including skyrocketing health care costs, increased consolidation in the healthcare sector, and the heightened penetration of private equity in health care systems.

The proposed sale of two safety net hospitals — from private equity-backed Prospect Medical Holdings to the nonprofit Centurion Foundation — has been closely watched across the state. The Attorney General's updated terms for the sale reflect growing concern over the role of private equity in Rhode Island’s health care system.

A large number of nonprofit hospitals located in urban cities are exploiting a Medicare definition that allows them to be considered both “urban” and “rural” simultaneously, letting them tap generous benefits and reimbursement models specifically intended for rural communities.

Drugmakers are experimenting with direct-to-consumer sales in response to Trump’s push for lower drug prices, aiming to bypass traditional middlemen like PBMs. While the strategy could reshape how patients access medications, experts warn its impact on affordability, safety, and equity remains uncertain.

Traditional Medicare plan holders have typically not had to wait for prior authorization before receiving medical treatment. CMS recently announced a new program to test prior authorization requirements for certain services in six states to root out fraud, waste and abuse. Jeffrey Marr highlights what’s needed to set up a well-functioning prior authorization system.

Another news article speaks on a study published in Health Affairs that reveals a sharp rise in urban hospitals reclassifying themselves as "rural" under Medicare rules, allowing them to access financial benefits intended for rural health providers. Researchers warn that this loophole could redirect billions in federal funds away from genuinely rural hospitals and urge policymakers to take corrective action.

Hundreds of large, urban hospitals have taken advantage of a 2016 policy change to classify themselves as both urban and rural, allowing them to access financial benefits meant for rural hospitals. Researchers warn that this loophole could divert billions in taxpayer funds away from actual rural communities and into already well-funded urban hospitals unless policymakers intervene.

This piece, authored by Hayden Rooke-Ley, argues that while the Trump administration’s One Big Beautiful Bill Act threatens to gut Medicaid funding by nearly $1 trillion over a decade, states still have powerful tools to protect coverage and even strengthen their healthcare systems. By capping inflated prices in the private insurance market and redirecting those savings to Medicaid—where every dollar is federally matched—states can blunt the impact of federal cuts, support vulnerable providers, and reduce systemic inequities.

The article investigates how major drugmakers like Pfizer and Eli Lilly are paying telehealth companies millions of dollars to connect patients to providers, raising concerns about potential conflicts of interest and violations of anti-kickback laws. While both companies deny influencing prescriptions, lawmakers and experts worry these partnerships may steer patients toward expensive branded drugs and allow pharma firms to collect detailed patient data.

This article talks about two commentaries by Hayden Rooke-Ley that argue that neoliberal, profit-driven models of U.S. healthcare—particularly privatized Medicare and value-based payment—have failed patients by prioritizing corporate interests over access and quality of care. He calls for a shift to a publicly governed, single-payer system that removes financial conflicts of interest and restores decision-making to non-commercial entities and caregivers.

This article covers a study in JAMA Health Forum finds that private equity-acquired gastroenterology practices significantly raised colonoscopy prices without any improvement in quality of care. The rise in costs was especially steep in highly consolidated markets, where prices surged by 6.7%. With no measurable gains in patient outcomes, the findings raise broader concerns about the impact of PE’s profit-driven model on healthcare affordability, transparency, and value.

This article argues that despite Massachusetts’ recent reforms after the collapse of Steward Health Care, a major loophole still allows private equity to control medical practices through shell companies and “friendly physician” arrangements. Drawing on the century-old corporate practice of medicine (CPOM) doctrine, the article calls for stronger legal restrictions like those recently passed in Oregon to protect patient care from financial interests.

This article reports on a study by Daniel R. Arnold, and colleagues who find that private equity-acquired gastroenterology practices significantly increase colonoscopy prices—by 4.5% more than independent practices—without improving care quality. Despite claims that consolidation boosts efficiency, the analysis showed no statistical difference in quality measures, raising concerns about affordability and access.

A bipartisan group of lawmakers has introduced legislation to stop Medicare Advantage insurers from collecting billions in federal payments for veterans who primarily receive care through the VA. Sparked by a Wall Street Journal investigation—supported by data from Brown University researchers—the bill aims to close a loophole that enabled an estimated $44 billion in excess payments from 2018 to 2021.

This article reports on a FTC study highlighting how roll-up acquisitions of physician practices—often led by private equity firms—can harm competition, raise prices, and reduce care quality. The study calls for increased scrutiny of serial acquisitions that fall below federal reporting thresholds, and experts say it could lead to stronger antitrust enforcement in healthcare markets.

This article discusses how financial pressures, staffing shortages, and management decisions at Wisconsin’s Group Health Cooperative have led to a unionization effort by primary care providers, reflecting broader national challenges facing independent primary care.

Several states are adopting hospital price caps to curb rising healthcare costs, citing limited success from other reforms. Supporters see savings, while hospitals warn of revenue loss and service cuts. See what CAHPR's Roslyn Murray, Ph.D. has to say.

Nominated by Arnold Ventures, Dr. Singh joined over 100 global fellows in Colorado in June 2025 to explore how market forces are reshaping health care at this year’s “Payoff: Investing in Health” conference by the Aspen Institute.

On Wednesday, the state House passed Senate Bill 951, the latest effort to expand Oregon’s prohibitions on corporate ownership in local care providers.

This news video features Dr. Andrew Ryan, Director of CAHPR, discussing his study on Rhode Island’s hospital affordability standards, which led to significant hospital price and premium reductions—saving $1,000 per fully insured member by 2022.

Professors Erin Fuse Brown and Yashaswini Singh warn that private equity’s focus on short-term returns is reshaping healthcare at the expense of patients and providers. From overburdened hospitals to ethical dilemmas in mental health care, their insights expose how profit-driven ownership can undermine clinical priorities and public trust.

This article reports on a study by CAHPR researchers that found that Rhode Island’s 2010 hospital price growth cap significantly reduced hospital prices and lowered premiums for fully insured health plans by $1,000 per member annually by 2022. However, the policy had limited impact on the self-insured market due to federal ERISA regulations, and the resulting hospital revenue losses have raised concerns about financial sustainability and care quality.