Growing consolidation amongst hospitals, doctor practices, and different well being care entities is driving up well being care costs. On the similar time, rising corporatization of well being care makes it more and more exhausting to uncover which entities personal or management a well being care follow or different well being care entity. As state policymakers grapple with excessive and rising business well being care costs, they confirmed a rising curiosity throughout 2025 legislative classes in leveraging possession transparency as a instrument to raised perceive their altering well being care markets, strengthen oversight efforts, and inform shoppers.
Payments to extend the transparency of possession and management of well being care entities had been launched in at the least eight states in 2025, and made it throughout the end line in 4 of them. The rise in state policymakers’ curiosity and exercise doubtless displays a number of interrelated elements, together with:
This weblog put up examines the function of state possession transparency inside broader reform efforts and evaluations possession transparency-related legal guidelines handed in 2025 in Massachusetts, Indiana, New Mexico, and Washington, in addition to payments thought-about, however not enacted, in Maine, Minnesota, Texas, and Vermont.
Who owns or controls a doctor follow, hospital, and different suppliers—and their vested monetary pursuits—can affect costs charged, companies provided, high quality, and entry to care, but it may be exhausting or unimaginable to know which entities personal or management a well being care follow or facility. An online of advanced company buildings amongst interrelated entities can obscure the possession or controlling pursuits of particular person practices or amenities, in addition to general traits in consolidation in well being care markets. Present knowledge sources on possession have gaps, and there’s no full, publicly obtainable knowledge supply with possession info for doctor practices.
States typically acquire some possession info as a part of state licensure of, for instance, hospitals and well being insurers. Some states go additional, amassing further info to leverage possession transparency as a instrument for monitoring and understanding their altering well being care markets. Possession transparency efforts, the place they exist, typically require: (1) annual or periodic reporting, and/or (2) reporting triggered by proposed modifications, comparable to mergers and acquisitions. These two buildings serve totally different functions and will be complementary:
- Annual reporting allows an possession registry that may present info—some or a lot of it in any other case unknowable—to a number of forms of customers. It may, for instance, permit a person affected person to be taught whether or not their physician’s workplace is owned or managed by a hospital, an insurance coverage conglomerate, Amazon, personal fairness, or different company entities. Annual reporting may assist reveal the diploma of consolidation in well being care markets in the present day and the character of relationships between entities. This will inform state policymakers, regulators, and researchers looking for to raised perceive their markets or restrict anticompetitive practices. Massachusetts has the longest-standing mannequin for this method that requires a spread of supplier organizations to systematically report possession and management info regularly, which the state then makes publicly obtainable.
- Notices of proposed transactions alert states to impending or potential modifications to possession or management. They’ll present info vital for state certificates of want or pre-transaction evaluation and oversight packages. Notices will be made public or stored confidential. Even in states that lack authority to administratively evaluation or approve/reject proposed well being care transactions, a broad requirement for well being care entities to offer advance discover of transactions permits the state to trace patterns of consolidation and absolutely leverage current state antitrust authority. At the least 35 states require hospitals, and in some instances, different well being care entities, to offer discover of sure proposed transactions or modifications.
Transparency alone can not forestall dangerous consolidation nor deal with anti-competitive conduct, as higher calibrated instruments can. However transparency offers insights into altering well being care markets and may function a basis for or complement to further methods to handle consolidation and management the expansion in business well being care costs.
Massachusetts’ Registration of Supplier Organizations (MA-RPO) program requires supplier organizations that meet sure income and affected person thresholds to yearly file possession, monetary, and different info with related state companies. As well as, giant suppliers should submit a discover of fabric change 60 days earlier than proposed modifications, together with mergers and acquisitions. This info informs the state’s market oversight and evaluation capabilities, and Massachusetts publicly posts the supplier registry knowledge and materials change notices to permit policymakers, researchers, and market members to grasp and enhance the state’s well being care system.
The 2024 collapse of Steward Well being Care, which stemmed partly from destabilizing personal fairness techniques, offered a stress take a look at for these state packages and uncovered just a few blind spots. In response, Massachusetts enacted a regulation in January 2025 that, amongst different provisions, closed loopholes that had successfully exempted many personal fairness and company buyers from supplier transparency and oversight necessities. The regulation extends MA-RPO reporting necessities to incorporate new info associated to non-public fairness buyers, actual property funding trusts, and administration companies organizations, and will increase the penalties for failing to report info from $1,000 per week to $25,000 per week. The regulation additionally provides particular transactions– comparable to personal fairness taking possession or management of a supplier group and a big switch of belongings, together with the sale and subsequent lease-back of a well being care supplier’s actual property –to the state’s record of fabric modifications that require an advance discover.
Indiana enacted a slate of well being care value containment payments in 2025, together with HB 1666, which requires a spread of well being care entities that function in Indiana to report possession info to the state regularly. An analogous invoice didn’t move the yr earlier than. The regulation applies broadly to well being care suppliers (although sure practitioner-owned practices are exempted) together with well being insurers, well being upkeep organizations (HMOs), third-party directors (TPAs), and pharmacy profit managers (PBMs). These entities should typically disclose the entities or those that maintain an possession or controlling curiosity or curiosity as a non-public fairness accomplice to an relevant state company. Hospitals, insurers, HMOs, TPAs, and PBMs should report yearly and are topic to fines for noncompliance. Well being care suppliers apart from hospitals should report each different yr and are usually not topic to fines.
The Division of Well being should compile the possession info reported to numerous state companies into an annual report and put up it on-line. As filed, the invoice would have made this possession info publicly obtainable, however as handed, it incorporates broad exclusions. The state could omit the identify of an individual or entity that holds an possession stake in any well being care entity, in addition to possession info that’s not broadly obtainable to most people. It stays to be seen whether or not the knowledge launched below this regulation may, for instance, assist an individual perceive which entity owns or controls their physician’s follow. The Division of Well being can, nevertheless, share possession info with the Workplace of Legal professional Normal, which is permitted below this regulation to analyze the market focus of a well being care entity at any time, along with its current authority associated to well being care antitrust investigations.
In April, New Mexico enacted a regulation to increase and develop expiring state regulatory authority from the Well being Care Consolidation Oversight Act handed the earlier yr. HB 586 authorizes state regulators to supervise proposed transactions, together with a change in possession or management of a hospital, a change accountable for the true property on which a hospital is positioned, and the acquisition of an impartial supplier follow by an insurer or its associates. The up to date regulation provides transparency provisions that the prior model lacked. It requires the New Mexico Well being Care Authority to publicly put up discover of and take public touch upon proposed transactions. The company should additionally yearly put up hospital possession on its web site and supply updates when there are modifications to a hospital’s possession or the true property on which it stands. HB 586 handed on the heels of the failure of a separate oversight invoice that included extra strong reporting on possession and management of well being care entities.
Washington enacted a regulation that lays the groundwork for future possession transparency. The preamble of the brand new regulation explains that Washington is at present ill-equipped to observe traits in its well being care market, together with vital consolidation amongst well being care entities and a pointy enhance in personal fairness acquisitions, and perceive their impacts on well being care entry and affordability.
The regulation directs the Division of Well being, in session with different state companies, to develop a plan for a “full and interactive registry” that makes well being care entity possession and management clear. The Division should specify which entities ought to report (together with at the least well being techniques, amenities, suppliers, insurers, and well being care profit managers) and what info needs to be collected. The regulation acknowledges the complexity in unearthing layers of often-obscured possession or management and requires methods to grasp direct and oblique possession and management (and modifications to them) by monitoring company buildings, funding, and contractual relationships. The Division should submit a progress report back to the legislature by the top of 2027 and a remaining report by late 2028. Lawmakers allotted $500,000 for the biennium to develop the plan.
Lawmakers in Maine, Minnesota, Texas, and Vermont filed possession transparency payments in 2025 that didn’t finally make it throughout the end line. These payments would have required sure well being care entities to report on their possession each yearly and after a cloth change, and knowledge would have been made publicly obtainable. The payments would have typically required well being care entities to reveal the entities or people that maintain an possession, funding, or controlling curiosity in them, together with their vital fairness buyers and relationships with administration companies organizations.
The states that handed possession transparency payments up to now in 2025 exhibit that progress is feasible in states with starkly totally different political environments, although in some instances, solely after a multi-session effort. Laws thought-about in 2025 additionally exhibits that states are responding to the growing corporatization of well being care by tailoring transparency necessities to seize which company actors exert management over a well being care entity’s operations or take possession of its actual property, even when they don’t instantly personal the well being care entity. Curiosity in possession transparency could proceed to develop as state policymakers search instruments to assist inform shoppers, management the expansion in well being care costs, and mitigate harms from consolidation in well being care markets.
