Rising consolidation amongst hospitals, doctor practices, and different well being care entities is driving up well being care costs. On the identical time, rising corporatization of well being care makes it more and more onerous to uncover which entities personal or management a well being care observe 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 periods in leveraging possession transparency as a instrument to higher 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 have been launched in not less than eight states in 2025, and made it throughout the end line in 4 of them. The rise in state policymakers’ curiosity and exercise seemingly displays a number of interrelated elements, together with:
This weblog put up examines the function of state possession transparency inside broader reform efforts and critiques possession transparency-related legal guidelines handed in 2025 in Massachusetts, Indiana, New Mexico, and Washington, in addition to payments thought of, however not enacted, in Maine, Minnesota, Texas, and Vermont.
Who owns or controls a doctor observe, hospital, and different suppliers—and their vested monetary pursuits—can influence costs charged, companies supplied, high quality, and entry to care, but it may be onerous or unimaginable to know which entities personal or management a well being care observe or facility. An online of advanced company constructions amongst interrelated entities can obscure the possession or controlling pursuits of particular person practices or amenities, in addition to total traits in consolidation in well being care markets. Present information sources on possession have gapsand there’s no full, publicly obtainable information supply with possession info for doctor practices.
States typically gather some possession info as a part of state licensure of, for instance, hospitals and well being insurers. Some states go additionalamassing 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 constructions serve totally different functions and might be complementary:
- Annual reporting permits an possession registry that may present info—some or a lot of it in any other case unknowable—to a number of sorts of customers. It might, 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, non-public fairness, or different company entities. Annual reporting may assist reveal the diploma of consolidation in well being care markets right now and the character of relationships between entities. This could inform state policymakers, regulators, and researchers searching for to higher perceive their markets or restrict anticompetitive practices. Massachusetts has the longest-standing mannequin for this method that requires a variety 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 will present info vital for state certificates of want or pre-transaction evaluation and oversight packages. Notices might be made public or saved 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 totally leverage present state antitrust authority. No less than 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 tackle anti-competitive habits, as higher calibrated instruments can. However transparency offers insights into altering well being care markets and might function a basis for or complement to further methods to deal with 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 businesses. As well as, massive 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 features, and Massachusetts publicly posts the supplier registry information and materials change notices to permit policymakers, researchers, and market contributors to grasp and enhance the state’s well being care system.
The 2024 collapse of Steward Well being Care, which stemmed partially from destabilizing non-public fairness ways, 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 provisionsclosed loopholes that had successfully exempted many non-public fairness and company traders from supplier transparency and oversight necessities. The regulation extends MA-RPO reporting necessities to incorporate new info associated to non-public fairness traders, 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 non-public fairness taking possession or management of a supplier group and a big switch of property, together with the sale and subsequent lease-back of a well being care supplier’s actual property –to the state’s listing of fabric modifications that require an advance discover.
Indiana enacted a slate of well being care price containment payments in 2025, together with HB 1666which requires a variety of well being care entities that function in Indiana to report possession info to the state regularly. An analogous invoice did not go 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 folks that maintain an possession or controlling curiosity or curiosity as a non-public fairness companion 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 will not be topic to fines.
The Division of Well being should compile the possession info reported to varied state businesses 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 might omit the title of an individual or entity that holds an possession stake in any well being care entity, in addition to possession info that isn’t broadly obtainable to most of the people. It stays to be seen whether or not the knowledge launched underneath this regulation might, for instance, assist an individual perceive which entity owns or controls their physician’s observe. The Division of Well being can, nevertheless, share possession info with the Workplace of Legal professional Basic, which is permitted underneath this regulation to analyze the market focus of a well being care entity at any time, along with its present authority associated to well being care antitrust investigations.
In April, New Mexico enacted a regulation to increase and broaden 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 actual property on which a hospital is positioned, and the acquisition of an unbiased supplier observe 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 actual 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 presently ill-equipped to observe traits in its well being care market, together with important consolidation amongst well being care entities and a pointy enhance in non-public 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 businesses, 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 not less than well being techniques, amenities, suppliers, insurers, and well being care profit managers) and what info ought 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 constructions, funding, and contractual relationships. The Division should submit a progress report back to the legislature by the tip of 2027 and a closing report by late 2028. Lawmakers allotted $500,000 for the biennium to develop the plan.
Lawmakers in Maine, Minnesota, Texasand 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 fabric 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 important fairness traders and relationships with administration companies organizations.
The states that handed possession transparency payments to date 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 of 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 might 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.
