Sept 10 All – Stakeholder Member Meeting

This meeting will feature Antonio Ciaccia, President of 3 Axis Advisors and a nationally recognized expert in healthcare drug pricing and policy. Antonio will provide an overview of the current industry players, drug pricing trends, and opportunities to address drug affordability. 

Karen Handorf, J.D., a Full Professor of the Practice at Center on Health Insurance Reforms (CHIR) and an ERISA attorney, will provide an update on the latest employer lawsuits and discuss strategies for mitigating risk through fiduciary oversight and contracting.

To round out the meeting, Jessica Brooks-Woods, CEO of the National Association of Benefits and Insurance Professionals, will join me on stage to discuss how employers can work with their brokers and consultants to drive drug affordability and accountability.

Please contact Sara Otte, sara@employersforumindiana.org for any meeting questions.

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Get to know the new CEO!

The EFI Team is thrilled to welcome Randa Deaton as our new President and CEO. Take a few moments to get to know her with the below quick Q/A!

What drew you to the Forum and what project or initiative are you most excited to work on? 

I could not be more excited and honored to join EFI; I consider it one of the most influential and impactful state employer coalitions in the country. After working for many years in this space in Kentucky and at a national level, I am most excited to be working and collaborating with employers in my home state of Indiana to drive improved health care affordability and quality on behalf of Hoosier workers and families.

What inspired you to pursue a career in this industry, and how has your journey shaped your perspective on healthcare?

My passion for improving health care comes from both my personal and professional experiences over the last two decades. As part of my role in benefit strategy at Ford Motor Company, I was charged with engaging and collaborating with peer businesses in Greater Louisville to improve healthcare quality and affordability; here I learned the power of collective impact to drive improved transparency, accountability, and health outcomes. I also spent over a decade as a caregiver to a family member with a serious illness, and here I learned what exceptional and accessible care looks and feels like and its extraordinary impact on individuals and families. I believe we should all be working together to ensure access to exceptional care that optimizes outcomes.

What are some of your favorite activities or hobbies outside of work?

My husband and I love to travel, camp, watch sports, and hang out with our adult sons. We spend half the year weekend camping (or glamping) at Indiana State parks with friends and family hiking, biking, and sitting around the fire. The other half of the year is spent at IU football and basketball games cheering on the Hoosiers – a family tradition from both of our families. 

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Texas Employers for Affordable Healthcare / Houston Business Coalition on Health

Texas Employers for Affordable Healthcare / Houston Business Coalition on Health

PODCAST: Listening In (With Permission): LINK

Andréa Caballero (Catalyst for Payment Reform) talks with Chris Skisak, Executive Director of Texas Employers for Affordable Healthcare and the Houston Business Coalition on Health, to explore how Texas employers are fighting back against hospital consolidation, opaque contracts, and rising healthcare costs.

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Hospitals:

• Construction On $4.3B Downtown IU Health Hospital Complex Nears Halfway Mark (IBJ)
• Ascension Enters Agreement To Acquire Amsurg Outpatient Centers (Modern Healthcare)
• IU School of Medicine Opens New $230M Education and Research Building (IBJ)
• 2025 Scorecard on State Health System Performance (Commonwealth Fund)
• Community Health Network President Bryan Mills Announces Retirement After Four Decades of Service (CHN)
• Ascension St. Vincent Celebrates Blessing, Ribbon Cutting of Lucas Family Brain and Spine Hospital (Ascension)

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Policy:

• Scott Signs Bill Capping Drug Prices at Vermont Hospitals (Seven Days)
• Why One State Banned Corporate Ownership Of Doctors’ Offices (Modern Healthcare)
• What Health Care Provisions of the One Big Beautiful Bill Act Mean for States (NASHP)
• 2025 State Legislative End-of-Session Recap (CAHPR)
• Reining in Hospital Prices (US of Care)
• HHS Report Marks A Potential A Turning Point In Health Care Competition (Health Affairs)

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Pharmacy:

• Prices For Obesity Drugs Fall, But Affordability Still Out Of Reach For Many (IBJ)

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Public Health / Patients:

• Indiana’s Overall Child Well-Being Improves, With High Rankings In Economic And Education (ICC)
• Indiana Health Department Reports Potential Record-Low Infant Death Rate In 2024 (ICC)
• Doulas, Once a Luxury, Are Increasingly Covered by Medicaid — Even in GOP States (KFF)
• Surprise Medical Bills Were Supposed To Be a Thing of the Past. Surprise — They’re Not. (KFF)

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Insurers:

• Health Insurers Promise To Improve Coverage Reviews That Prompt Delays, Complaints (IBJ)
• Insurers Vow To Make Prior Authorization For Treatment Easier. What That Means. (Washington Post)
• Indiana Chamber Will No Longer Have Anthem As Provider For Small-Business Health Coverage (IBJ)

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Provider / Physician:

• An Attack on the Medical Establishment Buried in an 1,800-Page Regulation (NYT)
• Hospitals Scoop Up Physician Practices, Driving Prices Up (Axios)

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Other:

• Price Changes: January 2000 to December 2024 (LinkedIn)

Employers:

• Podcast: No Extra Care, Just Extra Cost: Facility Fees with Patricia Kelmar (CPR)
• Survey: 36% of Employers Now Cover GLP-1’s for Weight Loss and Diabetes (BenefitsPro)

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Hospitals:

• Podcast: Hospital Consolidation Across Geographic Markets with Katie Gudiksen and Brent Fulton (CPR)
• Making Hospital Tax Breaks Work for Communities (Lown Institute)
• Nonprofit Hospitals Are Quiet Quitting Their Charitable Missions (The Well News)
• 100 Rural Hospitals Have Closed Labor and Delivery In 5 Years: Report (Beckers)
• FTC, Indiana AG Urge Rejection of HCA, Union Health Merger (Beckers)
• Beyond Cost Shifting: Market Power as the Key Driver of Hospital Prices (ERIC)

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Pharmacy:

• Roche Diagnostics Hopes New Self-Collection HPV Test Will Expand Screening for Cervical Cancer Risk (IBJ)
• The 25 Most Expensive Hospital Drugs (Becker’s)

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Public Health / Patients:

• 29 Million Americans Can’t Afford Health Care, Highest Number Since 2021 (Benefits Pro)
• In U.S., Inability to Pay for Care, Medicine Hits New High (Gallup)
• Podcast: Winning a Two-Year Fight Over a Bogus Bill (An Arm and A Leg)
• Preserving Young Patient’s Hair Prompts IU Surgeons’ Invention (IBJ)

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Policy:

• How Much Will That Surgery Cost? Hospital Prices Remain Largely Unhelpful. (KFF)
• Braun’s ‘Make Indiana Healthy Again’ Plan Tightens Food Stamp Requirements, Examines Hoosier Nutrition (IBJ)
• Indiana Lawmakers Send Hospital Pricing Legislation to Braun (IBJ)
• States Take The Reins on Insurance Reform (Politico)

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Other:

• Improving Price Transparency Data: Recommendations From Practice (Health Affairs)

Interested in past meeting topic or presentation? All past EFI All-Stakeholder Meeting presentations are freely and publicly available here. Check out top of mind healthcare topics today!

Texas Employers for Affordable Health Care

Webinar: Employer Health Care Data Field Guide

When: April 17, 2025 at 1pm ET

Registration: Link

Overview: During this webinar, the Employer Health Care Data Field Guide will be unveiled. The Guide is a one-of-a-kind roadmap for navigating the complexities of healthcare data access. The Guide’s author, Chris Deacon will guide attendees through its content including:

•  Making the Most of the Data
• The Importance of Healthcare Data for Plan Sponsors
•  Fiduciary Duty of Plan Sponsors
•  Primer on Laws & Regulations
•  How to Get the Data, including letter templates and responses to TPA objections

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National Alliance of Healthcare Purchaser Coalitions

Download The Resource: PBM Misalignment Initiative: Final Report

Overview: The National Alliance PBM Misalignment Initiative investigates and addresses misalignment between employers and their pharmacy benefit management (PBM) service providers. 

Building on the 2023 PBM Playbook and other related resources, this final report provides an overview of the current PBM landscape, examines factors driving misalignment, and identifies actionable steps employers can take to improve PBM practices and prices.

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Employers:

• Transparency and Accountability: The Path to Meaningful Health Care Pricing Reform (ICC)
• Even ‘Good’ Employers Face Rising Risk of Lawsuits Over Health Plan Costs (Benefits Pro)
• New Tools to Health Employers Ensure Compliance with Mental Health Parity and Addiction Equity Act Released (National Alliance of Healthcare Purchaser Coalitions)

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Hospitals:

• Indiana System Signs Definitive Agreement to Acquire 19th Hospital (Beckers)
• Indiana Hospital Merger Would Lead to Higher Health Care Prices and Job Losses (Yale)

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Insurer:

• UnitedHealth to Reimburse Pharmacies More for Brand-Name Drugs (Modern Healthcare)
• UnitedHealth Group PBM to Cut Some Drug Reauthorization Requirements (Modern Healthcare)

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Private Equity:

• State Spotlight: New Massachusetts Law Enhances Oversight of Private Equity in Health Care (CHIR)

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Pharmacy:

• Medicare Part D Spending on 10 Diabetes Drugs Hit $35.8B in 2023 (MedCity News)
• Novo Nordisk Launches Lower-Cost Wegovy, Following Eli Lilly Into Direct-to-Patient Sales (MedCity News)

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Policy:

• State Leaders Downplay Concerns of Possible Federal Medicaid Cuts (IBJ)
• Indiana Lawmakers Seek To Forbid Hospital Monopolies, But One Merger Fight Remains (KFF Health News)
• Senate Committee Advances Hospital Price Bill, But Expects More Changes (IBJ)
• Power, Money and Finger-Pointing: Gov. Braun Picks a Side in Muddy Health Care Price Fight (Indy Star)

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Other:

• What Does the Future Hold for Public Health Funding? (ICC)
• Time for More Changes to Hoosier Hospitals (Indiana Capital Chronicle)
• Americans Borrow Estimated $74 Billion for Medical Bills in 2024 (Gallup)
• John Arnold’s Top Three Health Care Reforms (AV)

Interested in past meeting topic or presentation? All past EFI All-Stakeholder Meeting presentations are freely and publicly available here. Check out top of mind healthcare topics today!

Midwest Business Group on Health

Webinar: Empowering Employers: Experts Weigh in on CGM Technology, Benefits, and the Need for Choice

When: March 4, 2025 from 2-3:30pm ET

Registration: Link

Overview: If the question is, “What’s today’s game changer in diabetes management?” The answer can be summarized in just three letters — CGM. This free session will explore how Continuous Glucose Monitoring (CGM) can provide the data needed for individuals to make behavior changes and improve glucose control. Learn what industry experts recommend when it comes to health plan coverage of CGMs and how this technology can benefit individuals living with diabetes, types I and II. This webinar will offer valuable insights into harnessing the power of CGMs to transform how diabetes is managed at your organization.

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National Alliance of Healthcare Purchaser Coalitions

In Person Conference: 2025 Health Policy Summit

When: March 6, 2025 in Washington, DC

Overview: The Purchaser Business Group on Health and the National Alliance of Healthcare Purchaser Coalitions will co-host the 2025 Policy Summit.

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Employers:

• Employers Increasingly Promote Wellbeing To Workers (IBJ)
• Meet America’s Best Large And Midsize Employers 2025 (Forbes)

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Hospitals:

• Guardian Journalists Show The Harm Of Hospital’s High Prices (AHCJ)
• New 100-Bed Hospital With Maternity Services Coming To Hamilton County. Here’s Where (IndyStar)
• Indiana System Revives Bid For HCA Hospital (Beckers)
• Community Health Partnership Will Build 2 Behavioral Health Centers, Adding 240 Beds (IndyStar)

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Private Equity:

• Increases In Physician Professional Fees In Private Equity–Owned Gastroenterology Practices (Health Affairs)
• Variation In Hospital Salary Expenditures And Utilization Changes After Private Equity Acquisition, 2005–19 (Health Affairs)
• Changes in Patient Care Experience After Private Equity Acquisition of US Hospitals (JAMA)

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Pharmacy:

• Kroger Health Reunites With Express Scripts (Modern Healthcare)
• Drug Costs and Their Impact on Care: Insights from Medicare Patients and Providers (Commonwealth Fund)

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Policy:

• Indiana Lawmakers Toyed With Health Care Cost Bills For Years. Is This The Year For Change? (IndyStar)

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Other:

• From Laggard To Leader: Why Health Care In The United States Is Failing, And How To Fix It (Health Affairs)
• Understanding Health Care Price Variation: Evidence From Transparency-In-Coverage Data (Health Affairs)
• Bringing Hospital Care to Patients’ Homes (Washington Post)

Feb 14 Meeting

All Forum members are invited to our Forum All Stakeholder meeting on February 14th from 9:00 – 11:30am ET. Snacks will be provided and the full agenda can be found here.

If you are a Forum member and did not receive an invite, please contact Sara Otte at sara@employersforumindiana.org.

Midwest Business Group on Health

Webinar: Empowering Employers: Experts Weigh in on CGM Technology, Benefits, and the Need for Choice

When: March 4, 2025 from 2-3:30pm ET

Registration: Link

Overview: If the question is, “What’s today’s game changer in diabetes management?” The answer can be summarized in just three letters — CGM. This free session will explore how Continuous Glucose Monitoring (CGM) can provide the data needed for individuals to make behavior changes and improve glucose control. Learn what industry experts recommend when it comes to health plan coverage of CGMs and how this technology can benefit individuals living with diabetes, types I and II. This webinar will offer valuable insights into harnessing the power of CGMs to transform how diabetes is managed at your organization.

Employers:

• Purdue Remains No. 1 For Second Year in Healthiest Employers of Indiana (Purdue)

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Hospitals:

• Commercial Inpatient Hospital Price Growth Driven by System Affiliation and Nonprofit-Status Hospitals (HCCI)
• A Busy Hospital M&A Period Continues (Beckers)
• Indiana Hospital to Rebrand After Joining Deaconess Health (Beckers)

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Providers & Physicians:

• Three of Indiana’s Leading Independent Orthopedic Practices Announce Merger to Form OrthoIndiana (OrthoIndy)

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Private Equity:

• Growth of Private Equity and Hospital Consolidation in Primary Care and Price Implications (JAMA)

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Pharmacy:

• 6 Drugs Now in Shortage (Beckers)
• Where Smaller PBMs are Headed this Year (Modern Healthcare)
• Lilly Acquires Scorpion Therapeutics in Deal Worth up to $2.5B (IBJ)
• FTC Releases Second Interim Staff Report on Prescription Drug Middlemen (FTC)
• Largest Pharmacy-Benefit Managers Hiked Up Drug Prices, FTC Says (WSJ)

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Policy:

• Indiana Nonprofit Hospitals Sitting on Billions of Dollars Worth of Net Assets, Legislator Says (IBJ)
• FTC Updates Merger Reporting Rules: 5 Things to Know (Beckers)
• Braun Signs Executive Orders on Abortion Records, Health Care Costs (ICC)

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Public Health

• Biden Administration Moves to Ban Medical Debt From Credit Scores (NYT)

2024 Year-in-Review

Thank you for another productive year of meetings, discussions, collaboration, and networking! 

To explore highlights of the past year, including key meetings, projects, and initiatives, check out our 2024 Year in Review presentation.

If you missed a meeting or need to revisit any materials, visit our website for links to all of our past slide decks and resources.

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Refreshed Data in Sage Transparency

On December 17th Sage Transparency was updated with data from RAND 5.1 (see the next section for details), CMS Hospital Quality and Patient Experience Star Ratings, CMS Hospital Readmission Penalties, and Quantros Hospital Quality Reliability Scores.

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Recent Presentations

In November, Gloria Sachdev was invited to present for the following organizations where she shared market and policy ideas to advance transparency, affordability, and competition:

• November 12th: National Association of Health Data Organizations
• November 20th: Georgetown University
• November 22nd: Connecticut Office of Health Strategy

On December 10th, RAND Corporation released an update to round five of its employer-led price transparency study. This update incorporates additional claims data and refinements to their original analysis. Highlights include:

• In 2022, employers and private insurers paid an average of 254% of what Medicare would have paid for the same inpatient and outpatient hospital services at the same facilities (including both facility charges and related professional claims).
• State-level median prices have remained stable across the past three study rounds: 254% of Medicare in 2018 (Round 3, 2016–2018 data), 246% in 2020 (Round 4, 2018–2020 data), and 253% in 2022 (Round 5.1 — this study, 2020–2022 data).
• The new data includes trends in emergency service pricing at the state and national levels between 2018 and 2022.

Use the link below to download the updated report and supplemental data.

Each year, we are proud to honor outstanding individuals and organizations who are working to improve our healthcare systems. Please join us in congratulating both recipients on this well-deserved recognition. These trailblazers are truly making an impact and inspiring change across the country!

2024 EFI Dave Kelleher Leadership Award

Schweitzer Engineering Labs

Pamela Colley, Senior Public Affairs Manager
Chris Foutch, Senior Finance Supervisor

The amazing team at Schweitzer Engineering Labs (SEL) was awarded the 2024 Dave Kelleher Leadership Award for their dedication to advancing healthcare price transparency. SEL has demonstrated exceptional leadership through various initiatives, including establishing direct contracting, addressing price variations, leveraging claims data to eliminate hidden fees, and optimizing prescription drug management. Their support of market and policy initiatives that align payments with the value of services sets an example of the leadership this award celebrates.

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2024 Healthcare Innovation Award

Mark Cuban

Mark Cuban was awarded the 2024 Healthcare Innovation Award for his groundbreaking work with the Mark Cuban Cost Plus Drug Company, PBC. His transparent, no-nonsense approach to prescription drug manufacturing and pricing is revolutionizing the healthcare industry. By eliminating traditional middlemen like PBMs, Cost Plus Drugs has enhanced transparency and fostered trust among consumers and employers by providing access to safe, affordable medications.

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Employers:

• US Employers Prioritize Wellbeing but Miss the Mark with Employees (WTW)
• Small Businesses Search for Affordable Health Care (Matter of Fact)
• Why the U.S. Healthcare System is so Much Worse than its Peers (Harvard Business Review)

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Hospitals:

• Is Hospital Market Concentration Related to Medical Debt? (Urban Institute)
• Virtual Hospital-at-Home Could Offer Alternative to CMS Waiver (Modern Healthcare)
• Indiana Hospitals Pull Merger Application After Pushback Over Monopoly Concerns (KFF)
• 25 Largest Health Systems by Hospital Beds (Beckers)

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Providers & Physicians:

• Fact Sheet: Nursing Faculty Shortage (AACN)
• The Bad News Behind the Rise in Locum Tenens (MedScape)
• OrthoIndy and Indiana Hand to Shoulder Center Announce Alignment (OrthoIndy)

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Conglomerates:

• Justice Department Sues UnitedHealth Over Amedisys Deal (Beckers)

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Insurance:

• UnitedHealth Pays its Own Physician Groups Considerably More than Others, Driving Up Consumer Costs and its Profits (STAT)

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Pharmacy:

• Same Drug, 2,200 Different Prices (WSJ)
• U.S. Patent Office Pulls Controversial Rule to Curb Pharma Patent Abuse (STAT)
• How a Duty To Spend Wisely on Worker Benefits Could Loosen PBMs’ Grip on Drug Prices (KFF)

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Policy:

• CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS)
• New York Targets PBMs with New Transparency, Competition Rules (Modern Healthcare)
• Reporting of Health Care Entity Mergers and Acquisitions (IN.gov)
• Make America Healthy Again: 6 Healthcare Positions of RFK Jr. (Beckers)
• Hospital Payment Cap Simulator (Brown University)

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Public Health

• Seven Key State-Level Strategies for Supporting Community-Level Harm Reduction (NASHP)
• States Ranked by Preterm Birth Rates (Beckers)
• The Maternity Care Project

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Other Healthcare News

• View of U.S. Healthcare Quality Declines to 24-Year Low (Gallup)
• Everyone’s Mad at Health Insurers, But ‘There’s Plenty of Blame to Go Around’ (TradeOffs)
• It’s a Big Thing: Medical Spread Pricing. So, Let’s Talk About Contract Transparency, With Cynthia Fisher (Relentless Health Value)

Upcoming Meeting

Mark your calendar for our EFI Member All-Stakeholder Meeting November 12th, from 1:00 – 5:00pm ET! The Agenda is below and a calendar invite will be sent to members in early October.

1. Welcome and EFI Year in Review
2. Value Based Payments: What is it?
3. Indiana All-Payer Claims Database (APCD) Demonstration
4. Panel Discussion: Improving Access to Maternal and Infant Care
5. Awards / Closing
6. Networking Cocktail Hour

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Vice President Job Opening

The Forum seeks a highly organized Vice President to support our membership, education, and research efforts. The VP will work in tandem with the Forum’s CEO and Director of Business Operations to improve the value received by employers and patients for their health care expenditures. This role reports to the CEO. For more information go here. If interested in the position, please send a resume to Sara Otte at sara@employersforumindiana.org.

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Presentations

In October, Gloria Sachdev was invited to give presentations regarding market and policy ideas to advance transparency, affordability, and competition to the following organizations:

• October 28th: Center on Health Insurance Reforms at Georgetown University
• October 30th: Catalyst for Payment Reform

The 26th KFF Annual Employer Health Benefits Survey was released on October 9, 2024. The survey examines trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. This year, employers were also asked about their provider networks, abortion coverage, family building benefits, coverage for GLP-1 agonists as well as programs for lower-wage workers. The survey includes 2,142 interviews with non-federal public and private firms. Learn more about the report in these Wall Street Journal and Health Affairs articles.

Investigative journalist George Joseph’s released a report on October 17th revealing troubling insights into Parkview Health System. Despite being headquartered in the nation’s most affordable city, Parkview’s hospital prices rank among the highest in the country. Full report here. A follow up article was then released on October 24th with Hoosier employers, families and lawmakers weighing in on Indiana’s healthcare market. Read the follow up report here.

This report uncovers many of the deep-rooted inefficiencies that exist across the U.S. healthcare system including:

• The harmful effects of health system consolidation;
• aggressive billing practices;
• lack of transparency;
• high and variable pricing;
• cost shifting to commercial payers; and
• inequitable access to care.

When large systems dominate the market, the lack of competition leads to unchecked price hikes, leaving patients and employers without options. To ensure healthcare is affordable and accessible, we need meaningful reform that holds healthcare systems accountable.

National Alliance of Healthcare Purchaser Coalitions

In Person Conference: Manifesting a New Destiny: Employers Creating the Future of Healthcare

Agenda: Link

Date: November 18th – 20th

Registration: Link (EFI has a limited number of free registration codes. If you are an Employer Member of EFI and interested in attending this event, please contact Sara Otte at sara@employersforumindiana.org.)

Overview: The Annual Forum will take place in Arlington, VA, November 18-20, 2024. This event brings hundreds of employers, business coalition leaders, and healthcare stakeholders to discuss successful strategies and emerging trends in healthcare value; health policy; and benefits, wellbeing and health equity.

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Employers:

• Third Annual Conference Tackles the Cost of Hospital Care (City and State NY)
• 32BJ Health Insights 2024 Conference, The Price of Power: Confronting the Hospital Affordability Crisis (32BJ Health Insights)
• Employers Require More Health to Improve Health-Care Affordability (Bloomberg Law)
• Rising Health Care Prices are Driving Unemployment and Job Losses (Yale)
• A Five-Lever Framework For Pres (Benefits Magazine, pg 40)
• ICHRAs vs. Self-Funded Plans: Choosing the Best Health Benefits Solution for Your Employees (The Alliance)

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Hospitals:

• Methodist Hospital to Come Tumbling Down After IU Health Opens New Hospital (IBJ)
• IU Health Breaks Ground on Fort Wayne Hospital (Inside Indiana Business)
• Days of Cash on Hand at 35 Health Systems (Beckers)
• The $37.4 Billion Tilted Playing Field For Nonprofit Hospitals (Forbes)
• Parkview’s Pricing Again Comes Under Scrutiny (Journal Gazette)
• Ascension to Open $200M Indiana Women and Infants Hospital (Beckers)
• IU Health Bloomington Hospital Pays for Some Patients to Transfer to Bedford (IN Public Media)
• Shining a Light on Corporate Hospital Systems’ Role in Driving America’s Healthcare Cost Crisis (Hospital Watch)
• Indiana Hospital Association Names Longtime Health Care Leader as New President (IBJ)

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Providers & Physicians:

• Marathon Health Expands Network to 720 Locations (IBJ)
• Draft for Public Review and Comment: Principals for Alternative Payment Models (CPR)
• Health Care Administrators: A Call for Equal Transparency and Accountability (KevinMD)
• 11 Providers Being Acquired by Payers (Beckers)

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Conglomerates:

• Exclusive: CVS Explores Options Including Potential Break-Up, Sources Say (Reuters)
• CVS Lays Off 400+ at Aetna Headquarters (Beckers)
• UnitedHealth Posts $6.1B Profit in Q3 (Beckers)
• Meet UnitedHealth’s Executive Team (Beckers)
• Elevance Health to Make $11.9M Expansion in Indianapolis, Add 230 Jobs (IBJ)
• Elevance Posts $1B Profit in Q3, Lowers Earnings Forecast (Beckers)
• Kroger Sells Specialty Pharmacy Unit to Elevance (Beckers)

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Insurance:

• Patient Safety Experts Want Progress on Quality Measure Alignment (Modern Healthcare)
• Aetna Launches Deductible-Free Plan: 5 Notes (Beckers)
• Biden Administration Proposes a Rule to Make Over-The-Counter Birth Control Free (NPR)
• “Not Medically Necessary”: Inside the Company Helping America’s Biggest Health Insurers Deny Coverage for Care (ProPublica)
• Labor Department, UnitedHealth Settle Alleged Emergency Claims Issues (Beckers)

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Pharmacy:

• Why Your Pharmacy Experience Is Miserable (Time)
• State Insulin Copay Caps (American Diabetes Association)
• What Went Wrong at CVS? (The Week)
• How Would Authorizing Medicare to Cover Anti-Obesity Medications Affect the Federal Budget? (CBO)
• Cell and Gene Therapy Approvals Drive Paradigm Change in Manufacturing (Pharmaceutical Technology)
• A Free Drug Experiment Bypasses the US Health System’s Secret Fees (Bloomberg)
• Walgreens to Close 1,200 Locations as Retail Sales Decline (Washington Post)
• Walmart Plans to Deliver Prescriptions Nationwide in as Little as 30 Minutes (CBS News)
• A Report in Response to the Executive Order on Lowering Prescription Drug Costs for Americans (CMS)
• FDA Authorizes Marketing of First Home Flu and COVID-19 Combination Test Outside of Emergency Use Authorities (FDA)

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Policy:

• Feds Back Healthcare Workers in Noncompete Lawsuit (Modern Healthcare)
• Lawmakers Scrutinize “Black Box of State PBM Spending” (ICC)
• How State Policy Makers Can Tackle Medical Debt: Lessons From North Carolina (Health Affairs)
• FTC Objection to Proposed Terre Haute Hospital Merger Centers on Controversial State Law (Indiana Lawyer)
• Key Committee to Vote on Maryland Drug Affordability Board Plan (WYPR)

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Public Health

• In Landmark Move, EPA Requires Removal of All U.S. Lead Pipes in a Decade (Washington Post)
• 2024 Health of Women and Children Report (America’s Health Rankings)

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Other Healthcare News

• Medicare Plans Are Making Big Changes for 2025. Here’s How to Navigate Them. (WSJ)
• Healthcare Executive Pay Jumps 4.6%: 5 Notes (Beckers)
• An Epic Dystopia: How a Near-Monopoly Gained Control of Most of the Nation’s Electronic Medical Records, to the Detriment of Medical Practice and Doctor Morale (The American Prospect)
• The Incursion of Profit-Enhancing Middlemen In US Health Care (Health Affairs)

Upcoming Meeting

Mark your calendar for our EFI Member All-Stakeholder Meeting November 12th, from 12:30 – 5:00pm ET! The Agenda is below and a calendar invite will be sent to members in early October.

1. Networking Cocktail Hour
2. Networking Lunch
3. Welcome and EFI Year in Review
4. Value Based Payments
5. Indiana All Payer Claims Database (APCD) Demonstration (Q/A will not be available during the meeting. If you have any questions regarding the Indiana APCD, please email them to Sara Otte at sara@employersforumindiana.org by October 16th)
6. Panel Discussion: Improving Access to Maternal and Infant Care
7. Awards / Closing

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Presentations

In September, Gloria Sachdev was invited to give presentations regarding market and policy ideas to advance transparency, affordability, and competition to the following organizations:

• September 5th: Dallas Fort Worth Business Group on Health
• September 9th: Community Oncology Alliance
• September 11th: Cincinnati Business Coalition
• September 12th: Health Rosetta (received the Transparency Champion Award on behalf of all EFI members)

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New Website to Address Healthcare Prices

Brought to you in partnership between Catalyst for Payment Reform and Employers’ Forum of Indiana, a new campaign called Price Crisis attempts to provide healthcare related educational materials and stories. This is a soft launch website, which will be refined and updated in the coming months.

Read more about this upcoming resource here.

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Sage Transparency 2.0: Updated August 22, 2024

To provide you with the most current data we have available, Sage Transparency 2.0 data gets updated quarterly! On August 22nd, Sage Transparency was updated to reflect the July 2024 release of CMS Quality data and the July 2024 update of the NASHP hospital financial data.

The three candidates for Governor of Indiana have released their positions on healthcare.

National Alliance of Healthcare Purchaser Coalitions (NAHCPC)

In Person Conference: Manifesting a New Destiny: Employers Creating the Future of Healthcare

Date: November 18th – 20th

Registration: Link (EFI has a limited number of free registration codes. If you are an Employer Member of EFI and interested in attending this event, please contact Sara Otte at sara@employersforumindiana.org.)

Overview: The Annual Forum will take place in Arlington, VA, November 18-20, 2024. This event brings hundreds of employers, business coalition leaders, and healthcare stakeholders to discuss successful strategies and emerging trends in healthcare value; health policy; and benefits, wellbeing and health equity.

Available Now

As of late September 2024, residential households in the U.S. are eligible to receive another order of 4 free at-home tests at this link.

• Each order includes 4 individual rapid antigen COVID-19 tests (COVIDTests.gov has more details about at-home tests, including extended shelf life and updated expiration dates).

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Employers:

• US Employers Expect Nearly 6% Spike in Health Insurance Costs in 2025, Mercer Says (Reuters)
• Workers, Employees Likely to See Another Stiff Increase in Health Benefits (IBJ)
• These Alabama Workers Were Swamped by Medical Debt. Then Their Employer Stepped In. (KFF)
• 32BJ Labor Industry Cooperation Fund Releases Interactive Tools to Help Employers and Unions Achieve Lower Hospital Prices (Morning Star)

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Public Health:

• Addressing the Crisis in Rural Maternity Care (CHQPR)
• First on CNN: US Faces Maternity Care Crisis, with 1 in 3 Counties Lacking Obstetric Doctors to Provide Care, Report Warns (CNN)

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Hospitals:

• FTC Opposing Union Health Acquisition of Terre Haute Regional Hospital (Inside Indiana Business)
• Former State Officials File Medicaid Fraud ‘Whistleblower’ Lawsuit Against Insurers, Hospitals (WVPE)
• Whistleblowers: Indiana Medicaid Overpaid Up To $700M Amid Lobbying, Political Pressure (IndyStar)
• Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System (Commonwealth Fund)

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Providers & Physicians:

• How a Leading Chain of Psychiatric Hospitals Traps Patients (NYT)
• Jury Finds BCBS Louisiana Shortchanged Surgical Center by $400M (Beckers)
• Insurer-Provider Contract Impasses Leave Many Patients Without Care (IBJ)

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Insurance:

• CVS’s Medicare Woes Continue to Fuel More Cuts to Its Outlook (WSJ)
• HCSC Offering Large Employers Health Plan With No Deductible (Modern Healthcare)
• Elevance Health Acquiring IU Health Plans (IBJ)
• Insurers Expand Coverage Of Prescriptions Written By Pharmacists (Forbes)

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Pharmacy:

• Humira Biosimilar Price War Update: Should We Be Glad that CVS Health and Express Scripts Are Using Private Label Products to Pop the Gross-to-Net Bubble? (Drug Channels)
• Vermont Attorney General Files Unfair Trade Practices Lawsuit Against Caremark and Express Scripts for Inflated Drug Costs (Frier Levitt)
• When Is The Price Of A Drug Unjust? The Average Lifetime Earnings Standard (Health Affairs)
• Walgreens to Pay $106.8 Million Over Alleged Fraudulent Healthcare Billings (WSJ)
• Cigna Demands FTC Retraction in Escalating Drug-Price Fight (WSJ)
• Sanders: Ozempic Generics Could Cost 90% Less Than Brand-Name (Beckers)
• 5 Ozempic Updates (Beckers)
• PBM: FTC Accesses Drug Middlemen of Inflating Insulin Prices (Fox)
• FTC Sues Pharmacy Insurance Managers, Alleging Unfair Drug Prices (Washington Post)
• FDA Approves First Self-Administered Flu Vaccine Spray (CBS)
• LinkedIn Post from Chris Deacon Regarding PBMs

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Policy:

• Op-ed: Shawn Gremminger and Bret Jackson: What is Hospital Dumping and Why Should Legislators, Employers and Patients Care? (Washington Reporter)
• Statement of Russell DuBose, Testimony to the House Committee on Education and the Workforce (National Alliance of Healthcare Purchaser Coalitions)
• PBM Audit Report for Indiana Employee Health Plan and Medicaid Plans (RX Connection)

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Other Healthcare News

• Private Equity Acquisitions Of Hospices Are Increasing; Ownership Remains Opaque (Health Affairs)
• Closing Remarks by Professor Phil Phan at the Johns Hopkins 2024 Symposium on Health Policy

Transparency Champion Award

EFI is honored to receive the Transparency Champion award, presented by Dave Chase of Health Rosetta at Indiana’s Top Health Plans conference on 8/6/24 hosted by Conner Insurance, a Forum member. Thank you Dave Chase and Ben Conner!

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Presentations

In August, Gloria Sachdev was invited to give presentations regarding market and policy ideas to advance transparency, affordability, and competition to the following organizations:

• August 5th: Indiana Top Health Plans
• August 6th: Marathon Health
• August 22nd: National Associations of Worksite Health Centers, co-hosted by EFI
• August 27th: Association of Health Care Journalists

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EFI Award Nominations

We are currently taking nominations for our Innovation in Healthcare, and Leadership in Healthcare Awards. Both awards will be presented at our November 2024 All-Stakeholder Meeting. You are welcome to self nominate or nominate someone. Please send nominations to Sara Otte at sara@employersforumindiana.org.

Sage Transparency 2.0: Updated August 22, 2024

To provide you with the most current data we have available, Sage Transparency 2.0 data gets updated quarterly! On August 22nd, Sage Transparency was updated to reflect the July 2024 release of CMS Quality data and the July 2024 update of the NASHP hospital financial data.

Now Available!

The Indiana All-Payers Claims Database (APCD) is now live! This has been a long time coming as in 2020 Indiana lawmakers established the development of an APCD via SEA 5. This was a priority policy initiative of EFI.

Many thanks to Jonathan Handsborough, Executive Director of the Indiana APCD, and his team at the Indiana Department of Insurance, for their commitment and efforts to bring healthcare price and quality transparency to Hoosiers. We have had the pleasure of working with Jonathan for several years and believe this to be a good first step. Jonathan will be presenting at our November 12th Forum All-Stakeholder meeting… He requests EFI send all questions to him ahead of time. As such please send your questions to Sara Otte at sara@employersforumindiana.org by October 16th.

Purchaser Business Group on Health

Webinar: 2024 Maternal Health & Birth Equity Summit

Date: September 18th from 10am – 6pm ET (8am – 4pm MT)

Registration: Link (Forum Employer Members can email Sara Otte at sara@employersforumindiana.org for a discount code for complimentary registration)

Overview: This summit will bring together employers, public purchasers, providers, plans, patients, and government agencies to discuss strategies to address maternal morbidity and mortality, eliminate disparities and improve birth outcomes. This event is a call to action. Attendees will walk away with clear steps that they can take (both individually and collectively) to positively impact the future state of U.S. maternity care.

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Midwest Business Group on Health (MBGH)

Webinar: Keeping Up with the Ever-Changing Landscape of Obesity Management

Date: September 18, 2024 from 9:30am – 5:00pm ET (8:30am – 4:00pm CT)

Registration: Link, (Employer Non – MBGH Member Registration Fee: $100)

Overview: In today’s workforce, combating obesity is paramount for fostering employee health and well-being. The changing landscape of treating obesity as a disease demands strategic attention from employers. Employers are increasingly being asked to consider pharmacological interventions along with traditional behavioral health programs to manage obesity in their employee population. The question for many employers is, “Can this be done in cost-effective manner?” Join MBGH to explore fresh perspectives on implementing a holistic, inclusive and cost-effective obesity management strategy within your organization.

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Kentuckiana Health Collaborative (KHC)

In Person Conference: Aligning for Whole Person Health

Date: September 18th – 19th beginning at 12pm ET

Registration: Link (Non-KHC Members: $400)

Overview: Join the Kentuckiana Health Collaborative at our 10th Annual Conference on September 18-19, 2024, at the Galt House Hotel in Louisville, KY to learn about the importance of whole person health and hear from thought leaders and experts on how we can implement a holistic approach to care. The conference will emphasize applying a whole person health approach on maternal health, mental health, and obesity – three high priority conditions for the US and the Commonwealth of Kentucky. These are also the KHC’s three strategic focus areas.

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National Alliance of Healthcare Purchaser Coalitions (NAHCPC)

In Person Conference: Manifesting a New Destiny: Employers Creating the Future of Healthcare

Date: November 18th – 20th

Registration: Link (EFI has a limited number of free registration codes. If you are an Employer Member of EFI and interested in attending this event, please contact Sara Otte at sara@employersforumindiana.org.)

Overview: The Annual Forum will take place in Arlington, VA, November 18-20, 2024. This event brings hundreds of employers, business coalition leaders, and healthcare stakeholders to discuss successful strategies and emerging trends in healthcare value; health policy; and benefits, wellbeing and health equity.

D

Register Today – November 20, 2024

Join the American Diabetes Association at The State of Diabetes for a panel discussion focused on the current landscape of diabetes and its financial impact on employers and employees. Discussion and networking will follow. 

Register for this free event here.

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Employers:

• Purdue Trustees Approve 2025 Health Plans with Modest Employee Premium Increase (Purdue University)
• Mark Cuban’s Big Warning for Employers (Becker’s)
• Wells Fargo Sued Over Drug Costs in Employee Health Plan (Modern Healthcare)
• New Pricing Data Fuel Employer Lawsuits Against Aetna (Modern Healthcare)
• Employer Sponsored Insurance Paid Twice as Much as Medicare for Services at Ambulatory Surgical Centers (HCCI)
• Aon: U.S. Employer Health Care Costs Projected to Increase 9 Percent Next Year (PR Newswire)
• 2025 Employer Health Care Strategy Survey (Business Group on Health)
• Surprise Billing Law Helped PE-Backed Providers (Axios)
• A Playbook for Employers Addressing Pharmacy Benefit Management Misalignment (National Alliance)
• Mental Health Initiative Guidebook Employer Mental Health Strategies, An Essential Investment (National Alliance)

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Mental Health:

• Enforcing Mental Health Parity: State Options to Improve Access to Care (Commonwealth Fund)

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Public Health:

• Tiny Shards of Plastic are Increasingly Infiltrating Our Brains, Study Says (CNN)

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Hospitals:

• 381 Hospitals with 5 Stars from CMS (Becker’s)
• Inside Ascension’s Growth Strategy, Per its President (Becker’s)
• Charitable Care from Hoosier Not-For-Profit Hospitals Remains Stagnant While Revenue Increases (IBJ)
• Gulf Widens Between Rich and Poor Hospitals (Axios)
• Why I’m Worried About Patient Care, Safety, Security at IU Health Bloomington (The Herald-Times)
• States Setting Health Care Spending Growth Targets Experienced Accelerated Growth in 2021 (Health Affairs)
• JLL Capital Markets Sells 64-Bed Inpatient Facility in Indianapolis Market (RE Journals)
• Tale of Two Hospitals: Why Some Hospitals Succeed and Others Do Not (Third Way)
• CEOs Earn Big Bucks at Nonprofit Hospitals. But Does that Benefit Patients? (NPR)

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Providers & Physicians:

• Rural Medicine: Caring for your Neighbors in Small Places (Indiana University)
• Walgreens May Sell Entire VillageMD Stake (Modern Healthcare)
• Claim Denials Becoming More of a Headache for Providers: Report (Modern Healthcare)
• Ambulatory Surgical Center Services: Status Report (MedPAC)
• Finding a Therapist Who Takes Your Insurance Can be Nearly Impossible. Here’s Why (NPR)

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Insurance:

• CVS Launches $2B in Cost Cuts, Aetna President Out (Modern Healthcare)
• UnitedHealthcare Embraces Consumerism (Beckers)
• Elevance Health Picks Leaders, Name for $4B Primary Care Venture (Becker’s)
• Centene to Cut Broker Commissions on Part D Drug Plans for 2025 (Modern Healthcare)

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Pharmacy:

• Sixty-Nine Percent of 340B Contract Pharmacies Were Associated with a PBM Through Vertical Integration or Contractual Arrangement (Avalere)

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Policy:

• Addressing Corporatization of Health Care, Consolidation, and Closures: Updated NASHP Market Oversight Model Legislation (NASHP)
• 120 – Day Review of Union – Regional Hospital Merger Begins (Tribstar)
• Medicare Site-Neutral Payments: A Commonsense, Bipartisan Reform (Paragon Health Institute)
• Report: Failing to Regulate Hospital Mergers Means Consumers Pay More (AHCJ)
• 2023 Data From The Independent Dispute Resolution Process: Select Providers Win Big (Health Affairs)
• FTC Ban on Worker Noncompete Deals Blocked by Federal Judge (Bloomberg Law)
• Political Polarization and Diverging Economies are Related (ICC)
• Prior Authorization Targeted by More and More States (Modern Healthcare)

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Private Equity

• Hospital Assets Before and After Private Equity Acquisition (JAMA)
• After Private Equity Takes Over Hospitals, They are Less Able to Care for Patients, Top Medical Researchers Say (NBC)

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Other Healthcare News

• Video: How Does Medical Debt Impact Your Credit Score (AHealthcareZ)
• Cross-Validation of Insurer and Hospital Price Transparency Data (AJMC)
• Vālenz Health Completes Acquisition of Healthcare Bluebook (Valenz Health)