Trump healthcare price transparency order may not bring intended relief to patients

By Amina Niasse  - A Trump administration executive order intended to provide patients with the prices from hospitals and insurers they need to shop around may prove ineffective because of the huge amount of unorganized data it will generate, experts say. Read Full Article…

HVBA Article Summary

1. Stronger Push for Price Transparency: A new executive order aims to fix flaws in previous hospital and insurer transparency rules by enforcing clearer, more specific guidelines. The goal is to make healthcare pricing data more accessible and accurate, but the decentralized format still poses major challenges for consumers.

2. Data Overload Without Usability: Although insurers and hospitals have reported billions of prices, the data is scattered across separate websites and difficult for patients to navigate. Experts argue that healthcare costs are too complex to be fully captured in machine-readable files, and price variability further complicates comparisons.

3. Enforcement and AI Could Be Game-Changers: Government agencies are now under instruction to step up enforcement, addressing previously low compliance rates. Meanwhile, advances in AI could help third-party platforms make the vast pricing data more usable for patients seeking cost-effective care options.

Senate report scrutinizes Medicare Advantage marketing spend, broker practices

By Rylee Wilson - Medicare Advantage insurers are spending an increasing amount on fees and commissions paid to brokers, a report from the office of Senate Finance Committee Ranking Member Ron Wyden found. Read Full Article… 

HVBA Article Summary

1. Senate Investigation into Medicare Marketing Practices: Sen. Ron Wyden announced plans to investigate five third-party organizations involved in marketing Medicare Advantage (MA) plans in 2024. A March 25 report revealed a significant rise in spending on agent and broker fees, jumping from $2.4 billion in 2018 to $6.9 billion in 2023, reflecting the growing reliance on third-party marketing to drive MA enrollment.

2. Concerns Over Oversight and Broker Incentives: The report highlights that federal and state governments have limited oversight over marketing firms contracted by insurers. It warns that the surge in marketing expenditures has created financial incentives for brokers to prioritize commissions, sometimes at the expense of enrollees' health needs, by limiting the plans presented to clients.

3. Policy Recommendations for Reform: To address these issues, the report recommends several reforms, including banning platforms that restrict broker plan visibility, granting CMS greater regulatory authority over marketing organizations, prohibiting offshore call centers, and requiring brokers and agents to act as fiduciaries. Industry leaders voiced cautious support but emphasized that marketing costs do not directly raise premiums or burden taxpayers.

NYMag: The Confessions of Insurance Executives

By Wendell Potter - I wanted to share a new piece in New York Magazine that profiles not just my own journey, but those of three other former insurance executives who, like me, walked away from the industry after realizing just how deeply broken it is. Read Full Article…

HVBA Article Summary

1. Whistleblowers with a Mission: A group of former insurance executives, including prominent figure Wendell Potter, have left behind lucrative careers to expose the dark realities of the industry. They reveal how the relentless pursuit of Wall Street profits often comes at the cost of patient well-being, shedding light on unethical practices they once helped uphold.

2. Atonement and Advocacy: Motivated by personal remorse and a desire to make amends, these insiders are now using their knowledge to challenge the dominance of for-profit insurers. Whether it's by aiding doctors in navigating complex insurance systems or pushing for single-payer healthcare, they're each playing a role in dismantling the system they once served.

3. A Moment for Change: With public anger toward insurers reaching new highs, these former executives believe the current environment presents a rare opportunity for reform. They see hope in the growing calls for accountability and are determined to turn insider truth-telling into a catalyst for long-overdue healthcare transformation.

How AI is reshaping the future of life insurance in 2025

By Frank Gargano - Artificial intelligence is becoming a looming presence over the life insurance field, signaling one of the largest in a wave of tech-focused changes coming to the industry. But with a sector as highly regulated as insurance, firms are left wondering how, and when, AI-powered tools can advance. Read Full Article…

HVBA Article Summary

1. AI and Automation Are Driving Investment and Transformation: A significant 78% of insurance professionals expect to increase their technology budgets in 2025, with a strong focus on adopting AI, machine learning, and blockchain. These tools are increasingly being implemented across critical areas like claims processing (36%), customer service (23%), and underwriting (16%), marking a shift from experimentation to practical, value-generating applications.

2. AI’s Promise Comes with Risk and Regulation Challenges: Despite its potential, AI adoption in insurance comes with notable concerns. Over half of respondents (51%) identified hallucinations—instances where AI generates false or misleading information—as the top risk. Additional concerns include regulatory struggles due to a lack of model transparency (46%) and increased data leak risks (43%), all of which could slow or complicate broader implementation.

3. Insurtech Innovation Is Redefining Customer Experience: Beyond operational efficiencies, insurance firms are also using tech to humanize the customer journey. Startups like Empathy are offering services that go beyond standard policies to support grieving families with estate management and care planning. Meanwhile, legacy firms like Manulife are finding success combining classical AI with GenAI to streamline back-office functions and improve processing rates, reinforcing AI’s role in the ongoing digital transformation of the industry.

Rising health care costs and the toll on employee wellbeing 

By Jeff Bak - This year, employer-sponsored health care costs are projected to rise at their highest rate in 13 years. Employers and benefits leaders across the country are now forced to ask a nearly impossible question: How can I protect my business’s bottom line while maintaining high-quality and affordable benefits for employees? Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Health Care Costs Are Driving Financial Strain: Even as employers have more than doubled their contributions to employee health care over the past two decades, many Americans still can’t afford necessary care. A recent Gallup survey found that 12% of adults borrowed money for medical expenses — with nearly half borrowing over $1,000 — and 58% fear that a serious health issue could lead to medical debt, including 40% of those with high incomes.

2. Financial Stress Impacts Workforce Wellbeing: Health care affordability isn’t just a personal issue — it affects the workplace. Nearly 50% of employees say financial worries distract them during the workday, and 84% link those concerns to exhaustion and burnout. Skipping or delaying care due to costs can worsen physical health and lead to more missed work and long-term expenses, creating a harmful cycle.

3. Employers Should Rethink Health Plan Strategy: Traditional PPO plans, while convenient, often come with high premiums and out-of-pocket costs for employees. Employers should consider alternative models like reference-based pricing (RBP), which can reduce total health care costs by nearly 20%. These savings can be reinvested into better benefits, lower employee contributions, and enhanced financial wellbeing — improving retention, productivity, and overall employee health.

Top PBMs by 2024 market share

By Mackenzie Bean - Cigna’s Express Scripts has emerged as the largest pharmacy benefit manager in the U.S. by market share, overtaking long-time leader CVS Caremark,  according to a March 31 report from the Drug Channels Institute. Read Full Article…

HVBA Article Summary

1. Express Scripts Emerges as the New Market Leader: In 2024, Express Scripts captured 30% of all U.S. prescription claims — a sharp increase from 23% the previous year. This growth was largely driven by its acquisition of a major contract to manage pharmacy benefits for 20 million Centene members, previously served by CVS Caremark. The shift marks a significant realignment in the pharmacy benefit management (PBM) landscape.

2. CVS Caremark’s Market Share Drops Significantly: CVS Caremark saw its market share fall from 34% in 2023 to 27% in 2024, driven largely by the loss of the Centene contract. Once the dominant player in the PBM space, CVS now trails behind Express Scripts as competitive dynamics intensify among top industry players.

3. PBM Market Becomes Even More Concentrated: Together, Express Scripts, CVS Caremark, and Optum Rx processed 80% of all U.S. prescription claims in 2024 — up one percentage point from 2023. This continued consolidation underscores the growing influence of the top PBMs and raises questions about competition, pricing power, and access in the broader prescription drug market.

Income protection: Are your executives fully covered for disability?

By Harrison Newman - One of the ways organizations invest in attracting and retaining top executive talent is through comprehensive compensation packages. However, many companies overlook a critical gap in their executive benefits strategy: adequate income protection through disability coverage. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Standard Group LTD Plans Leave Executives Exposed: While many executives assume their employer-provided long-term disability (LTD) coverage is sufficient, standard plans often cap monthly benefits around $10,000—creating large gaps for high earners. For an executive earning $300,000 annually, this cap can result in a $60,000 yearly shortfall, threatening their ability to maintain their lifestyle during extended disability periods.

2. Comprehensive Risk Analysis is Essential for Closing Coverage Gaps: To ensure adequate protection, organizations must regularly benchmark their LTD benefits and assess risk exposure across the executive team. This includes evaluating total compensation—base salary, bonuses, commissions, and equity—and identifying where traditional plans fall short in replacing income.

3. Supplemental Disability Solutions Offer Tailored Protection: Individual disability insurance (IDI), high-limit policies, and executive carve-out plans provide flexible and portable options that go beyond standard group LTD. These solutions can protect total compensation, feature broader definitions of disability, and help companies attract and retain top talent through robust, customized executive benefits.