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The No Surprises Act (NSA) was created to help protect consumers with private insurance from surprise medical bills from out-of-network health care providers. The NSA requires the Department of Health and Human Services to prepare annual reports to Congress on the effects of the NSA's provisions. This report summarizes findings of an environmental scan on consolidation trends and impacts in health care markets. It describes the evidence on price, spending, quality of care, access, and wages in health care provider and insurance markets, as well as other market trends. The authors found strong evidence that hospital horizontal consolidation is associated with higher prices paid to providers and some evidence of the same for vertical consolidation of hospitals and physician practices. Health care spending is likely to increase in tandem with these price increases. Most studies find decreased or no change in quality of care associated with consolidation; however, findings differ by quality measures examined and setting. Horizontal consolidation of commercial insurers is associated with lower prices paid to providers as insurers gain market power in negotiations with providers, but the lower prices paid to providers do not appear to be passed onto consumers, who face higher premiums following insurer consolidation. There is insufficient evidence of the effects on patient access to care and health care wages. The few evaluations of state surprise billing laws have found heterogeneous effects on prices and have not directly examined effects on spending, quality, patient access, and wages.

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From Coverage to Care (C2C) launched in 2014 with the dual goals of helping consumers understand their health insurance coverage and connect to care and supporting organizations in the community as they assist consumers at various points in this process. The Centers for Medicare and Medicaid Services asked a team of RAND researchers to evaluate the effectiveness of C2C in meeting these goals. The authors present the results of their mixed-methods analysis, which included secondary analyses of product-ordering and other data, a survey of organizations placing C2C product orders, a survey of consumers who had and had not reported C2C, and four case studies in communities using C2C products tailored to meet their language or cultural needs. The authors detected a positive association between C2C dissemination and flu vaccination but did not detect associations between C2C and six other measures of primary care and emergency care utilization. Findings from the consumer survey, which asked individuals whether they had ever seen C2C materials, suggest that those who were exposed to C2C were more likely to have high health insurance literacy, routine checkups, regular blood pressure monitoring, and flu vaccinations. Findings from the survey of organizations, which asked about dissemination channels, suggest that most organizations shared C2C materials with others in their community through distribution at events, talking to colleagues informally, or presenting C2C in a meeting or at an event. However, it is unclear how many of these efforts resulted in uptake by other organizations. RAND recommends a strategic planning approach to guide future dissemination efforts.