Dr. Oz outlines vision for CMS: 8 notes

By Jakob Emerson - CMS Administrator Mehmet Oz, MD, said April 10 that his vision for the agency includes a commitment to President Trump’s “Make America Healthy Again” agenda and modernizing Medicare, Medicaid and the ACA marketplace. Read Full Article… 

HVBA Article Summary

1. CMS to Expand Price Transparency and Program Integrity Efforts: CMS will enforce President Trump’s executive order mandating greater healthcare price transparency and ramp up efforts to identify fraud and abuse in Medicare Advantage, following concerns raised during Dr. Oz’s confirmation process. The agency also plans to halt certain state Medicaid payments to maintain the program’s core mission amid broader proposed federal cuts.

2. Policy Shifts Focused on Prevention, Technology, and Chronic Disease Reform: CMS, under HHS Secretary Robert F. Kennedy Jr., will prioritize prevention, chronic disease management, and reforms related to food, environmental health, and regulatory agencies. Dr. Oz has promoted AI and machine learning, including AI avatars, as scalable tools to streamline healthcare and reduce administrative burdens.

3. Significant Medicare Advantage Updates and Pending Coverage Decisions: CMS finalized a 5.03% payment increase to MA plans for 2026, over double the previous administration’s proposal, and solidified rule changes around prior authorizations and supplemental benefits. However, decisions on expanding GLP-1 coverage and regulating AI in prior authorization were deferred to future rulemaking.

PLANSPONSOR Roadmap: Health Plan Fiduciary Duties- Data and Documents

By Remy Samuels - For fiduciaries of health care plans, having access to data and understanding the intricacies of pharmacy benefit manager contracts is necessary to conduct a prudent monitoring process. Speakers at PLANSPONSOR’s Roadmap: Health Plan Fiduciary Duties livestream on “Data and Documents” on Thursday discussed how plan sponsors can negotiate with their PBMs and third-party administrators to access the health plan data they need, as well as pitfalls to look out for in contracts with PBMs. Read Full Article… 

HVBA Article Summary

1. Plan Sponsor Fiduciary Duties: Managing a health plan requires active involvement in three key areas—contract negotiations, continuous monitoring, and performance audits. Plan sponsors must leverage claims data during negotiations for optimal terms, monitor the plan to catch discrepancies early, and conduct third-party audits to verify contractual compliance and financial accuracy.

2. Data Access Equals Leverage: Real-time access to detailed data—such as billed amounts, payments, and discounts—is essential for plan sponsors to mitigate fiduciary risk, understand population needs, and benchmark costs. Without this visibility, sponsors lack the insights needed to hold PBMs accountable and improve pricing transparency.

3. Importance of Contract Clarity and Independent Review: Complex or unclear PBM contract language can obscure true costs and create compliance gaps. Experts stress the need for clear definitions, market checks, and third-party validation to ensure plan sponsors understand the financial impact of contract terms and avoid relying solely on internal advisers or brokers.

For hospitals, tariffs could mean higher prices ‘almost immediately’

By Ron Southwick - Hospitals won’t have much time before they see higher prices on medical devices and supplies. After moving ahead with aggressive tariffs on most of America's trading partners, roiling global markets, President Trump announced Wednesday that he is pausing higher tariffs on most countries for 90 days. But tariffs remain in place for China, which produces medical supplies hospitals use each day. In fact, Trump has raised tariffs on goods imported from China to 125%. Read Full Article…

HVBA Article Summary

1. Rising Supply Costs Will Hit Hospitals Hard: New tariffs on medical supplies and devices—excluding pharmaceuticals for now—will quickly raise costs for hospitals, particularly for items heavily sourced from China like gloves, masks, syringes, and IT equipment. Experts warn that these expenses, which make up over 20% of hospital budgets, will strain already tight margins, as providers have little ability to pass on these costs.

2. Nonprofit Hospitals Face Renewed Financial Strain: The tariffs come at a delicate time for nonprofit hospitals, many of which were only beginning to recover from pandemic-related challenges. Fitch Ratings notes that with operating margins typically just 3–4%, even slight increases in expenses could stall recovery, especially for hospitals that haven’t yet returned to pre-pandemic performance levels.

3. Limited Options for Relief or Adaptation: Hospitals may be forced to cut other expenses or face “permanently elevated costs” even if suppliers reshore production. Providers are requesting tariff exceptions and expressing concern over potential expansion to pharmaceuticals, which could further destabilize budgets and access to essential supplies.

Experts Push to Preserve Telehealth, Payment Parity Post Pandemic

By Brooke McCormick, Jason Bellet, Geoffrey Rutledge, MD, PhD, and Dan Nardi, MS - In various interviews with The American Journal of Managed Care®, experts highlight key health care infrastructure and policy changes that emerged from the COVID-19 pandemic and should be maintained long-term. All experts support the continued use of telehealth for the flexibility it provides to doctors and patients. Read Full Article…

HVBA Article Summary

1. Maintain Telehealth Payment Parity: Experts strongly support preserving telehealth payment parity, which ensures providers receive comparable reimbursement for virtual and in-person visits. This policy has expanded access to care—especially for rural and underserved communities—by enabling patients to consult specialists remotely without sacrificing provider compensation.

2. Make Virtual Care Coverage Permanent: The temporary policy changes made during the pandemic demonstrated the effectiveness, affordability, and convenience of virtual care. Experts argue these changes—especially coverage through Medicare and commercial insurers—should be made permanent to enhance care access and reduce system-wide costs.

3. Embrace Flexible, Value-Based Care Models: Panelists advocate for sustained investment in hybrid care models that combine telehealth and in-person visits based on patient needs. This flexibility, coupled with a shift toward value-based care, supports better patient outcomes and reduces inefficiencies tied to fee-for-service reimbursement systems.

Benefits Think: Why gratitude and support are the missing pieces in workplace well-being

By Shaye-Ann Hopkins and Kahini Shah - The U.S. workplace is at a tipping point. Roughly two-thirds (66%) of employees say they feel disengaged, and nearly a fourth (22%) are experiencing burnout amid a swirl of economic and political uncertainty. For younger workers, in particular, disengagement is rooted in a deep-seated feeling of being undervalued and unsupported. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Small acts of gratitude and support can significantly boost employee well-being and workplace outcomes: Research shows that simple gestures like thank-you notes or supportive messages increase happiness, appreciation, and job satisfaction. These interventions also help employees on short-term disability return to work more quickly, highlighting their impact on both morale and recovery.

2. Gratitude serves as a powerful, low-cost tool for driving organizational improvement and morale: Across industries, gratitude has been shown to improve mental health, strengthen team collaboration, and increase organizational commitment. In workplace settings, it supports better outcomes for employees, including those navigating short-term disability, by reinforcing a sense of value and connection.

3. Fostering a culture of connection helps meet employees’ core psychological needs and supports resilience during health-related absences: Rather than relying on expensive wellness programs, employers can create a more connected, engaged workforce through small, intentional actions. These practices are especially beneficial for employees on short-term disability, promoting a sense of belonging that supports recovery and return-to-work efforts.

NCQA Urges Expedited Adoption of Digital Quality Measures

By David Raths - A set of policy recommendations from the National Committee for Quality Assurance (NCQA) stresses the importance of building a strong digital health infrastructure that facilitates seamless exchange, promotes adoption of digital quality measures and maximizes the full potential of interoperable healthcare data via FHIR API implementations. Read Full Article…

HVBA Article Summary

1. Accelerate Digital Quality Measure (dQM) Adoption and Interoperability: NCQA urges HHS to prioritize the transition to FHIR-based digital quality measures to improve reporting accuracy and adaptability across healthcare settings. It recommends a clearer national framework for digital data exchange, faster integration of USCDI+ datasets into regulations, and inclusion of Medicare Advantage Star Ratings to incentivize standardized data sharing.

2. Advance Behavioral Health Integration and Quality Standards: NCQA calls for federal support to help behavioral health providers adopt certified EHRs, while protecting privacy and minimizing fraud. It also recommends funding the development of a quality measures cascade for substance use disorder care, to support consistent care standards and drive value-based care transformation.

3. Refocus CMMI Models on High-Impact, Tech-Driven Innovation: NCQA encourages CMMI to design new care models targeting high-cost, high-volume conditions and procedures with significant variability. It advocates for AI-powered shared care plans, increased FHIR data exchange adoption, and co-developed AI tools to support more personalized, efficient care and empower patient decision-making.

HR’s path to 4X better employee wellbeing: Why trust is the game changer

By Jill Barth - In 2025, the employee experience has reached a pivotal turning point, as technological advancements for improving the workplace are finally becoming a reality. New research highlights that HR leaders play a crucial role in fostering trust and enhancing employee wellbeing, both essential components of a positive employee experience. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Employee well-being is declining across the board: MetLife’s study shows significant drops in health, productivity (5%), and engagement (7%), highlighting a critical need for HR leaders to take action. With 81% of employees saying it’s their employer’s responsibility to build trust, organizations must focus on fostering care and connection.

2. Trust is a key driver of health and engagement: Employees who feel trust and care at work are nearly 4x more likely to report holistic well-being and over 2x more likely to be engaged. With employees 1.5x more likely to trust their employer than other institutions, HR teams have a unique opportunity to drive positive outcomes through supportive workplace cultures.

3. A strong benefits experience builds trust and resilience: Positive experiences with benefits make employees 2.4x more likely to feel holistically healthy and twice as likely to trust their employer. Key trust-building actions include open communication, recognizing good work, and year-round, personalized benefits engagement—not just during enrollment season.