PLANSPONSOR Roadmap: Fiduciary Process Action Plan

By Remy Samuels - Just as plan sponsors must uphold their fiduciary duties when managing their retirement plans, the same is true for health care plans, which require thorough documentation, requests for proposals, committee-member training and more. When it comes to creating a “fiduciary process action plan,” Rory Kane Akers, vice president and a senior ERISA compliance attorney at Lockton Companies, said at Wednesday’s PLANSPONSOR Roadmap livestream on health plan fiduciary duties that Step 1 is understanding who the plan fiduciaries are. Read Full Article…

HVBA Article Summary

1. Plan fiduciary identification and documentation gaps: Many employers and C-suite executives struggle to identify who their plan fiduciaries are, as plan documents often name entities rather than individuals. Companies must clearly define who is responsible for plan decisions, such as hiring vendors and managing contributions, to comply with ERISA standards.

2. Common fiduciary oversights in health plans: Experts highlighted that many plan sponsors fail to maintain updated plan documents reflecting benefit design changes and often lack clear eligibility criteria. These oversights increase litigation risks, with recent lawsuits targeting individual HR managers and board members for fiduciary breaches.

3. Best practices for strengthening fiduciary governance: To meet fiduciary obligations, organizations should establish a governance committee, routinely review and update plan documents, monitor vendor performance and fees, and ensure third-party administrators meet their contractual fiduciary responsibilities. Recent regulatory changes have also pushed employers to demand greater fiduciary accountability from vendors like PBMs.

Key Republican pushes for health benefits portability for gig workers

By Allison Bell - The leader of the Senate Health, Education, Labor and Pensions Committee is ramping up efforts to increase benefits portability by decreasing the chances that workers who get benefits from companies will be classified as the companies' employees. Sen. Bill Cassidy, R-La., the Senate HELP Chairman, posted a paper Wednesday that sketches out proposals for making it easier for freelancers, gig workers and other types of independent workers to keep their health insurance and other benefits throughout their careers. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Cassidy's Portability Proposals: Senator Bill Cassidy is advocating for Congress to create a "safe harbor" provision that would exclude questions about health benefits access from the legal test for determining if someone is an employee. He also proposes making it easier for independent workers to join association health plans, allowing them to access affordable health coverage without altering traditional employer-employee structures. Cassidy has prioritized increasing benefits portability for years, emphasizing that modernized labor laws are critical to supporting independent workers in today's economy.

2. Support and Opposition: Cassidy’s proposals are backed by gig economy platforms like DoorDash and benefits-focused companies such as Stride, who argue that improved portability would better serve independent workers. However, strong opposition comes from labor groups like the AFL-CIO, which contend that employers frequently misclassify workers as independent contractors to avoid providing mandated labor protections and benefits. These groups support stricter rules to preserve worker rights under existing employee classification standards.

3. Changing Political Landscape: The debate over worker classification could shift due to the backgrounds of new Trump administration officials. Labor Secretary Lori Chavez-DeRemer, with exposure to various types of independent healthcare workers through her husband's medical practice, and CMS Administrator Dr. Mehmet Oz, who worked with a mix of employees and freelancers during his television career, may bring more practical understanding of independent work realities. Their perspectives could influence how future benefits and classification policies are shaped.

Obesity drug coverage could lead to ‘substantial’ increase in Medicare spending

By Michael Monostra - Medicare Part D coverage of obesity medications could lead to a large increase in health care costs due to the prices of the drugs, according to data from a microsimulation model published in JAMA Health Forum. As Healio previously reported, CMS decided to not move forward with a previously proposed rule to have Medicare begin covering obesity medications in the 2026 calendar year, though the agency said it could reconsider the proposal in future rulemaking. Read Full Article… 

HVBA Article Summary

1. Projected Medicare Spending on Obesity Drugs: If Medicare covers obesity medications like semaglutide and tirzepatide, it would add approximately $47.7 billion in net costs over 10 years, even after accounting for $18.2 billion in savings from reduced obesity-related health conditions. Total drug spending could reach $65.9 billion by 2035, with substantial further growth projected through 2055.

2. Cost Variability Based on Drug Prices, Uptake, and Adherence: Sensitivity analyses showed that Medicare spending could vary dramatically depending on factors like drug discounts, patient adherence rates, and uptake levels. For instance, a 30% additional price discount and lower adherence would reduce 10-year costs to $17.9 billion, while higher adherence and moderate uptake could still keep spending above $40 billion.

3. Need for Lower Prices and Additional Interventions: Experts emphasized that the current high prices of semaglutide and tirzepatide make them not cost-effective for Medicare. Ongoing CMS price negotiations and increased competition are expected to drive prices down, but even with lower costs, alternative treatments will be necessary to maintain weight loss affordably over time.

Blue Shield of California exposed data of 4.7M people to Google

By Emily Olsen - The insurer said it severed the connection between Google Analytics and Google Ads early last year, and conducted a review to ensure no other analytics tracking software was exposing members’ protected health data. Still, Google may have used the information before the relationship between the services was cut to target ad campaigns to beneficiaries. Read Full Article…

HVBA Article Summary

1. Blue Shield Data Breach Overview: Blue Shield of California reported a significant data breach—the second-largest healthcare breach reported so far in 2025—caused by the use of online tracking technologies. Exposed information may include health plan details, online account data, location information, gender, family size, provider and patient names, medical service dates, and search activity from "Find a Doctor" tools. However, Social Security numbers, driver’s license numbers, and banking or credit card information were not compromised, according to the insurer.

2. Regulatory Scrutiny on Tracking Technologies: The breach draws attention to growing regulatory concerns over healthcare organizations’ use of online trackers embedded in websites and apps. Federal regulators have warned that these tools could inadvertently expose protected health information (PHI) to third parties. While the Biden administration attempted to restrict the use of such technologies, parts of the federal guidance were overturned after healthcare providers successfully challenged the limits in court.

3. Industry-Wide Challenges with Data Privacy: Blue Shield joins a growing list of healthcare organizations facing scrutiny over the use of tracking technologies, following large-scale breaches disclosed by Kaiser Foundation Health Plan (impacting 13.4 million members) and Cerebral (affecting 3.2 million users). Studies show that trackers like Meta Pixel are widely used on healthcare websites, raising ongoing concerns about the protection of sensitive patient information across the industry.

9 in 10 Americans have put off health checkups, life-saving screenings

By Michael Popke - Key findings from Aflac’s third annual “Wellness Matters Survey” reveal that most Americans (94%) put off getting a health checkup or screening that could help identify and treat serious illness early. Why? Fear of bad news, personal embarrassment, inconvenience, logistical barriers, and distrust or dislike of doctors — especially among younger adults — rank among the most common reasons, according to the survey. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Preventive care is often deprioritized until a health scare occurs: Although Americans recognize the importance of preventive care, behavior often lags behind; 65% only prioritize their health after a health scare, and those fearing a cancer diagnosis are paradoxically more likely to delay screenings (62% vs. 42%).

2. Logistical barriers, trust issues, and financial incentives heavily influence care-seeking behavior: Nearly half (48%) avoid routine checkups due to logistical challenges like childcare, work schedules, and transportation, while 26% cite distrust or embarrassment. Cash incentives (87%) and encouragement from loved ones (69%) are strong motivators for seeking preventive care.

3. Lack of insurance clarity and reliance on urgent care are prevalent, especially among younger adults and minorities: About 14% of Americans — and 18% of Gen Z — cite insurance issues as a barrier to preventive care, with many unsure if critical screenings are covered. Meanwhile, 1 in 5 Americans lack a primary care doctor, leading many, especially Gen Zers, millennials, and minority groups, to rely heavily on urgent care or emergency rooms for medical needs.

After Thompson killing, health insurers poured money into security

By Lauren Berryman - Publicly traded health insurance companies spent at least $3.3 million on personal security for top executives last year, mostly within the 27 days following the assassination of UnitedHealthcare CEO Brian Thompson on Dec. 4. UnitedHealth Group, CVS Health, Elevance Health, Centene and others urgently reassessed safety protocols for senior leaders after Thompson's murder, according to proxy statements they submitted to the Securities and Exchange Commission. Read Full Article…

HVBA Article Summary

1. Executive security escalation across health insurers: Following the fatal shooting of UnitedHealth executive Brian Thompson, health insurers rapidly increased security spending for top leaders. UnitedHealth Group alone spent over $2 million in a month on executive protection, family security, and funeral costs, with Centene, Elevance Health, CVS Health, and Molina Healthcare also significantly expanding protective measures for their executives amid rising threats.

2. New security protocols and board-level urgency: Companies have adopted extensive security measures beyond the norm, including armed guards, in-home security assessments, family protections, and stricter shareholder meeting protocols. Board members and compensation committees are no longer debating these expenses, treating executive protection as an essential business need rather than a discretionary perk, as reflected in new proxy statement disclosures.

3. Balancing security needs and organizational cost pressures: As the healthcare sector adapts to heightened threat levels, companies face challenges in determining which executives require enhanced security without inflating costs. Despite the discomfort of constant surveillance, improved protections have eased leadership fears and redefined risk management practices across the industry.

Gut Microbiome Likely Influences Neurodegenerative Disorders

By Christine Kilgore - Age-related neurodegenerative disorders — motor neuron diseases, demyelinating diseases, Alzheimer’s disease, and other proteinopathies — are at an “inflection point,” said researcher Andrea R. Merchak, PhD, with a fuller understanding of disease pathophysiology but an overall dearth of effective disease-modifying treatments. Read Full Article…

HVBA Article Summary

1. The gut-brain connection is critical for healthy brain aging: Merchak emphasized at the GMFH World Summit 2025 that the gut microbiome directly and indirectly influences brain health through mechanisms like microbial metabolites, vagus nerve communication, and immune system modulation. She urged closer collaboration between gastroenterologists and neurologists, highlighting that treating gastrointestinal health can have lasting impacts on brain aging and neurodegeneration risk.

2. Preclinical research shows gut microbiota can modulate neuroinflammatory diseases: Studies on multiple sclerosis (MS) models demonstrated that manipulating gut bile acid metabolism, particularly via the aryl hydrocarbon receptor (AHR) pathway, reduced autoimmunity and promoted recovery. Additional unpublished research suggests strong links between gut inflammation and neurodegenerative conditions like Parkinson’s disease and dementia, further supporting the gut-brain immune crosstalk concept.

3. Early clinical research suggests microbiome-modulating therapies may aid neurodegenerative diseases: Though current clinical studies are short-term, interventions like probiotics, prebiotics, diet changes, and fecal microbiota transplants (FMT) show promise. They have improved gastrointestinal and mood symptoms in Parkinson’s disease and MS, preserved cognitive function in dementia patients, and in some MS cases, even led to reported full functional recovery — although longer-term studies are needed to confirm these effects.