Here are seven types of “anticompetitive” clauses frequently seen in healthcare contracts:
1. All-or-nothing clauses: These require that if a payer wants to contract with a particular provider in a health system, the payer must contract with all providers in that health system.
2. Anti-tiering clauses: These restrict a payer from creating or altering a tiered network, block them from putting a provider in a nonpreferred network tier or require the payer to put all providers within a health system in the same tier.
3. Anti-steering clauses: These prevent a payer from using incentives and tools that encourage patients to use competing providers, even if those providers are more efficient or cost effective.
4. Exclusive contracting clauses: These bar a payer from including competing providers in their network, ensuring that the contracted provider is the only in-network option.
5. Most-favored nation clauses: These require a provider to give a payer the lowest rates of all payers they have contracted.
6. Gag clauses: These restrict the ability of a payer, plan administrator or provider to disclose price and quality information in contracts with government entities, patients or other parties.
7. Noncompete clauses: These prevent an employee from taking a job with a competing provider or starting a new practice within a given distance for a stated amount of time.
