/
The Role of State Government in Wisconsin’s Health Care Markets The Role of State Government in Wisconsin’s Health Care Markets

The Role of State Government in Wisconsin’s Health Care Markets - PowerPoint Presentation

cozync
cozync . @cozync
Follow
342 views
Uploaded On 2020-08-06

The Role of State Government in Wisconsin’s Health Care Markets - PPT Presentation

September 16 2016 Kevin OConnor 608 2842600 koconnorgklawcom 160964811 2 Overview Main Takeaways History of Health Care Transformation in WI in the1980s How Selffunding Will Affect These Markets ID: 799735

antitrust care state health care antitrust health state laws wisconsin competition markets history regulation closed funding takeaways rate setting

Share:

Link:

Embed:

Download Presentation from below link

Download The PPT/PDF document "The Role of State Government in Wisconsi..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

The Role of State Government in Wisconsin’s Health Care Markets

September 16, 2016

Kevin O’Connor

(608) 284-2600/

koconnor@gklaw.com

16096481.1

Slide2

2

Overview

Main Takeaways

History of Health Care Transformation in WI in the1980s

How Self-funding Will Affect These Markets

Slide3

I. Takeaways

A. Wisconsin enjoys cost-effective, high-quality health care, especially in South Central WisconsinWhy? In large part, it was the result of:- Application of antitrust laws to health care- Smart purchasing decisions by the state- Avoidance of ill-conceived regulation 3

Slide4

Takeaways

Self-funding Could Undermine These Policies and Results By:- Unraveling the integrated delivery of care- Complicates the state’s exercise of “buyer power” - Shifting risk to taxpayers of health care cost increases4

Slide5

WI Health Care History 101: Antitrust

Arizona v. Maricopa County Medical Society (1982): Supreme Court holds that health care entities subject to antitrust lawsProviders and Insurers Required to Compete on the Merits, Like Other IndustriesCaused Sea Change in Approaches to Health Care Competition and Collaboration5

Slide6

6

II. Purpose of Antitrust Laws

Antitrust laws promote business competition.

Competition is the best way to achieve low prices, high quality, and best service.

Potential antitrust issues arise whenever competition may be lessened.

By coordination among competitors; or

By strong firm's actions to limit weaker competitor's access to market.

Antitrust laws punish anticompetitive behavior

.

Slide7

History Continued: Closed Panels

State Regulatory Changes in 1980s- Wisconsin eliminates ban on closed panel plans - Prior to 1983, only two insurance companies operated in WI and, by law, they had totally open panels- Closed panels began to be formed as antitrust laws became relevant7

Slide8

More History: The State as Power Buyer

ETF develops aggressive bidding process for state employees in 1983Worked in tandem with antitrust enforcement and allowance of closed panelsCaused massive reorganization of markets in Dane County and, to lesser extent, in other parts of the state8

Slide9

The Result? Vertical Integration

South Central Wisconsin has three* vertically-integrated systems that compete vigorously1. Dean Health Plan/Dean Clinic/St. Mary’s Hospital2. Physicians Plus/Unitypoint Meriter/MMG3. Unity/UWH4. *GHCSCWBasic Economics: Intense competition = lower costs + improved quality9

Slide10

The Rest of the Story:

Dumb Regulation Avoided Regulation of Health Care Markets Can Undermine the Gains from CompetitionStates Can Exempt Private Anti-competitive Conduct from the Federal Antitrust Laws provided a State Actor Actively Supervises10

Slide11

Hospital Rate Setting

Mid-1980’s: WI allows hospitals to coordinate their pricing with rate-setting agreements - Clearly illegal under federal antitrust lawsReaction? State sets up Hospital Rate Setting Commission to dictate hospital ratesReplaced by Cost Containment Commission (CON “light”)—eventually abolished11

Slide12

COPA

Certificate of Public Advantage statutes passed by 20+ states, including WI, in 1990sPurported to immunize health care collaborations from federal antitrust Absence of supervising state actor undermined purpose- “Legitimate joint venture” allowed when clear conditions are met12

Slide13

Dodging the Bullet

Wisconsin is fortunate that the policies put in place in the 1980’s were not undermined by counter productive regulation and state policies13

Slide14

Can WI Dodge It Again?

Self-funding has superficial appeal, but- Will likely unravel connection between risk-bearing function and providing care- Change in incentives (essentially move to fee-for-service) antithetical to way these systems operate- Will allow providers to engage in opportunistic behavior 14

Slide15

OFFICES IN MILWAUKEE, MADISON, WAUKESHA, GREEN BAY AND APPLETON, WISCONSIN

AND WASHINGTON, D.C.

The presentation and materials are intended to provide information on legal issues and should not be construed as legal advice. In addition, attendance at a Godfrey & Kahn, S.C. presentation does not create an attorney-client relationship. Please consult the speaker if you have any questions concerning the information discussed during this seminar.

Questions

or Comments?

Kevin O’Connor (608) 284-2600

koconnor@gklaw.com

15