EP395: Consolidated Hospital Systems and Cunning Anticompetitive Contracts, With Brennan Bilberry

Consolidated Hospital Systems and Cunning Anticompetitive Contracts, With Brennan Bilberry (EP395)

Four Contract Terms Every Anticompetitive Hospital System Uses to Lock In Higher Prices. Episode 395.

Stacey Richter talks with Brennan Bilberry, founding partner of Fairmark Partners, about the four anticompetitive contract terms hospital systems use to consolidate market power and keep prices climbing.

WHAT YOU'LL LEARN

✅ How all-or-nothing contracting forces payers to include every hospital facility in-network at monopoly-level prices

✅ Why anti-steering and anti-tiering clauses eliminate any chance of using consumerism to route patients to better care

✅ What pricing gag clauses are and why they prevent employers and patients from knowing costs in advance

✅ How dominant hospitals use admitting privileges and referral leverage to control ostensibly independent providers

✅ Why hospital system consolidation functions as a flywheel: consolidate, force anticompetitive contracts, then raise prices

✅ What legal and legislative strategies are emerging to fight back against these anticompetitive practices

WHY THIS MATTERS

Anticompetitive hospital contract terms are normalized in healthcare in a way that would never be tolerated in any other industry. Bilberry's antitrust litigation work gives employers, TPAs, and legislators a concrete playbook for identifying and challenging the specific contract mechanics that lock communities into ever-rising hospital prices.

MENTIONED IN THIS EPISODE

EP373 with Cora Opsahl: Apple Podcasts | Spotify | Other Apps

EP249 with Dale Folwell: Apple Podcasts | Spotify | Other Apps

EP391 with Scott Conard, MD: Apple Podcasts | Spotify | Other Apps

EP389 with Mike Thompson: Apple Podcasts | Spotify | Other Apps

EP390 with Gloria Sachdev, PharmD, and Chris Skisak, PhD: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

06:16 What happens after a hospital consolidates?

07:23 What does an anticompetitive system look like when a hospital consolidates?

10:35 What are some anticompetitive "tricks" that hospitals employ?

12:37 The Sutter case in northern California.

14:50 What can you do if you're forced to engage in an all-or-nothing contract with a hospital system?

18:31 The Atrium case in North Carolina.

19:36 EP373 with Cora Opsahl.

21:33 What are price gag clauses?

23:08 How are legacy gag clauses designed to prevent scrutiny in litigation?

24:04 EP249 with Dale Folwell.

26:08 How do hospital restrictions on other providers create an anticompetitive environment?

27:23 EP391 with Scott Conard, MD.

29:48 EP389 with Mike Thompson or EP390 with Gloria Sachdev and Chris Skisak.