The No Surprises Act (NSA), part of the Consolidated Appropriations Act, 2021 (Pub. L.

116–260), 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, in conjunction with the Federal Trade Commission and Attorney General, to prepare annual reports to Congress on the effects of the NSA’s legislative provisions on patterns of vertical or horizontal integration of health care facilities, providers, group health plans, or individual health insurance issuers; overall health care costs; and access to health care items and services. To inform the broader public discussion about competition and consolidation in the health care sector, of which the NSA-mandated reports to Congress are a part, this report summarizes the findings of an environmental scan on consolidation trends and impacts in health care markets. It describes the evidence on consolidation trends and impacts on price, quality, and access in health care provider and insurance markets, as well as other market trends, which will be baseline information for the series of reports to Congress.

This research was funded by the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) and carried out within the Payment, Coverage, and Cost Program in RAND Health Care.

RAND Health Care, a division of the RAND Corporation, promotes healthier societies by improving health care systems in the United States and other countries. We do this by providing health care decisionmakers, practitioners, and consumers with actionable, rigorous, objective evidence to support their most complex decisions.

For more information, see www.rand.org/health-care, or contact