Will employer plan data be the next hot currency?

By Allison Bell – All U.S. employer health plans have dollars, many have euros, and some have crypto. Just about all have claims data. James Gelfand, the chief executive officer of the ERISA Industry Committee, wants employers, regulators and others to recognize that the plan information is a valuable form of currency. Gelfand talks about the value of health claims data in a comment on efforts by the Employee Benefits Security Administration — an arm of the U.S. Department of Labor — to implement proposed compensation disclosure requirements for pharmacy benefit managers and other employer plan service providers. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Claims Data as Compensation: The ERISA Industry Committee argues that access to employer health plan claims data should be treated as a form of compensation for plan service providers. This perspective could impact how the Department of Labor enforces compensation disclosure rules, potentially requiring service providers to be more transparent about their use and sharing of plan data. Recognizing data access as compensation may also strengthen employers' rights to obtain detailed claims information from third-party administrators and pharmacy benefit managers.

2. Growing Value of Plan Data in the AI Era: Law firm Bolton highlights that health plan claim information is becoming increasingly valuable due to the rise of artificial intelligence in healthcare. AI-driven care management and navigation tools rely on large datasets, making employer plan data a sought-after resource for technology firms. As the demand for such data grows, employers must be vigilant about how their data is secured and utilized by external partners.

3. Regulatory and Fiduciary Implications: If the Department of Labor adopts the view that access to plan data constitutes indirect compensation, service providers may face new disclosure obligations. This shift could enhance transparency for employer plan sponsors and fiduciaries, ensuring they are informed about how their data is used and monetized. Employers are encouraged to actively manage their data ownership responsibilities and scrutinize the security and application of their plan information.

Humana pulls back the curtain on planning for 2027 MA bids

By Paige Minemyer – Humana executives gave investors a peek Wednesday into the company's thinking around the 2027 Medicare Advantage bid cycle as elevated costs continue to sting the industry. CEO Jim Rechtin said during the insurer's earnings call that to achieve the goal of returning to a "stable margin" by 2028, it will need to look at adjustments to benefits. He did praise the Trump administration for shifting away from a flat 2027 rate proposal and instead choosing to finalize a slight increase, but said the change wasn't enough to account for rising costs. "This helps promote more stability in the industry as a whole, and it has a positive impact on the health of our seniors," he said. "Nevertheless, medical cost trend continues to outpace program funding." Read Full Article...

HVBA Article Summary

1. Strategic Adjustments for 2027 Bids: Humana is preparing for the 2027 Medicare Advantage bid cycle by considering benefit adjustments to address ongoing elevated medical costs. Leadership emphasized that while recent policy changes offer some industry stability, they do not fully offset the rising expenses. The company is leveraging its more mature transformation efforts to provide additional options for managing these financial pressures.

2. Financial Performance and Outlook: Despite a slight year-over-year dip in quarterly profit, Humana’s revenue grew significantly and exceeded analyst expectations. The company reaffirmed its outlook for 2026, projecting at least $9 per share in earnings and a medical loss ratio of 92.75%. Growth in Medicare Advantage membership and strong retention are expected to support continued revenue gains, though challenges remain.

3. Star Ratings and Legal Challenges: Humana faces headwinds due to a decline in the number of members enrolled in high-rated Medicare Advantage plans, which could negatively impact future quality bonus payments and revenues. The company’s legal challenge to the star ratings methodology was rejected in court, and the outcome of its appeal is uncertain. These ratings issues, along with higher acuity among new members, are contributing to increased costs and may affect Humana’s financial results in the coming years.

Slim chances of major health care legislation passing this year

By Susan Rupe – Health care affordability is a top priority for Washington lawmakers, but election-year politics, the Senate filibuster and a slim Republican majority cloud the outlook for passage of any major health care legislation this year. Geoff Manville, partner with Mercer’s Law and Policy Group, gave a rundown of what Congress is doing to address health care issues during a recent webinar. “Despite all the partisan acrimony, Congress is still focused on health care affordability,” he said. “A ton of bipartisan work is happening on legislation that largely aligns with employer health care priorities – themes of price transparency and costs. This work will continue into the next Congress regardless of party control.” Read Full Article...

HVBA Article Summary

1. Political Barriers to Major Legislation: The combination of election-year dynamics, the Senate filibuster, and a narrow Republican majority in Congress makes it unlikely that significant health care legislation will pass this year. These factors contribute to legislative gridlock, even as health care affordability remains a stated priority for lawmakers. The political environment is expected to delay any major reforms until after the current election cycle.

2. Incremental Reforms and Employer-Focused Changes: Despite the challenging legislative environment, several employer-friendly health care reforms have been enacted in recent years. These include increased transparency requirements for pharmacy benefit managers, price transparency rules, and reforms to provider billing and telehealth coverage. Such incremental changes demonstrate that bipartisan cooperation is possible on targeted issues, even when broader reforms are stalled.

3. Pending and Future Legislative Efforts: Multiple bills addressing health care transparency, affordability, and retirement policy are awaiting Congressional action. These proposals target issues like public reporting of health care prices, anti-competitive practices in provider contracts, and enhancements to health savings accounts. While these bills may not advance this year, ongoing bipartisan work suggests that health care reform will remain a focus in future Congressional sessions.

Payers promise standardized electronic prior auths

By Jacqueline LaPointe – Healthcare payers are serious about prior authorization reform, with leading health plans now promising to adopt a standardized electronic request process for most medical services. America's Health Insurance Plans (AHIP) announced on Friday that major payers have committed to an initiative to reduce the administrative burden of prior authorizations, while accelerating patient access to care. The initiative will apply to services commonly subject to prior authorizations, such as orthopedic surgeries and imaging, including CT scans and MRIs. Health plans signing on to the standardized electronic request process span commercial coverage, Medicare Advantage and Medicaid managed care, including industry heavy hitters The Cigna Group, UnitedHealthcare, Humana, CVS Health Aetna and various Blues plans. Read Full Article...

HVBA Article Summary

1. Industry-Wide Commitment to Electronic Standardization: Major health insurers have pledged to implement a standardized electronic prior authorization process for a broad range of medical services. This move is intended to reduce administrative complexity and speed up patient access to necessary care. The commitment covers commercial, Medicare Advantage, and Medicaid managed care plans, reflecting a significant industry shift.

2. Implementation Timeline and Scope: The participating payers plan to roll out the new electronic standards starting January 1, 2027, with the goal of covering over 70% of prior authorization volume by the end of that year. The process will be adopted on a rolling basis, and payers are working to expand the range of services included under the new system. Collaboration with technology companies and feedback from providers will be crucial to achieving widespread adoption.

3. Alignment with Federal Regulations and Provider Collaboration: The initiative aligns with recent federal requirements mandating standardized electronic prior authorization processes for government-sponsored health plans. Success will depend on effective collaboration between payers, providers, and technology partners to ensure seamless integration and robust data exchange. Addressing issues like incomplete documentation and ensuring real-time responses are key priorities to further streamline the process.

Employers are investing in virtual care to close healthcare gaps

By Paola Peralta – Digital solutions are cementing themselves as part of the healthcare landscape with more organizations signaling a willingness to make them a core part of their benefits offerings. Forty-four percent of employers are planning to introduce more virtual primary care in the next year, according to a recent report from independent insurance broker Brown & Brown, effectively turning digital-first healthcare solutions from a new innovation to a future expectation. This shift could radically change access to necessary care, address rising costs and improve health outcomes for employees of all ages. "The traditional telemedicine that we were all used to are really being taken over by a more virtual-first ecosystem," says Dannielle Sherrets, senior consultant of population health and wellbeing at Brown & Brown. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Virtual Care Becoming Mainstream: Employers are increasingly viewing virtual care as an essential part of their benefits strategy, with nearly half planning to expand virtual primary care offerings within the next year. This trend reflects a shift from telemedicine being a niche or emergency solution to becoming a standard expectation for employee healthcare. The move is driven by the potential to improve access, reduce costs, and enhance health outcomes across diverse employee populations.

2. Expanded Scope and Accessibility: Virtual care has evolved beyond its original focus on chronic disease management and pandemic-related needs. Now, it supports a wide range of services, including preventive care, mental health, medication management, and even in-home therapies. By removing barriers such as geography and transportation, virtual care allows employees to engage with healthcare providers more flexibly and conveniently.

3. Integration and Awareness Challenges: While virtual health solutions are becoming more embedded in insurance carrier networks, many employers and employees may not be fully aware of the available services. Experts recommend that organizations review their existing plans to identify hidden or underutilized virtual care options. Ensuring seamless coordination between virtual and in-person care is also critical to maintaining continuity and quality of healthcare for employees.

Payers promise standardized electronic prior auths

By Jacqueline LaPointe – Healthcare payers are serious about prior authorization reform, with leading health plans now promising to adopt a standardized electronic request process for most medical services. America's Health Insurance Plans (AHIP) announced on Friday that major payers have committed to an initiative to reduce the administrative burden of prior authorizations, while accelerating patient access to care. The initiative will apply to services commonly subject to prior authorizations, such as orthopedic surgeries and imaging, including CT scans and MRIs. Health plans signing on to the standardized electronic request process span commercial coverage, Medicare Advantage and Medicaid managed care, including industry heavy hitters The Cigna Group, UnitedHealthcare, Humana, CVS Health Aetna and various Blues plans. Read Full Article...

HVBA Article Summary

1. Industry-Wide Commitment to Electronic Standardization: Major health insurers have pledged to implement a standardized electronic prior authorization process for a broad range of medical services. This move is intended to reduce administrative complexity and speed up patient access to necessary care. The commitment covers commercial, Medicare Advantage, and Medicaid managed care plans, reflecting a significant industry shift.

2. Implementation Timeline and Scope: The participating payers plan to roll out the new electronic standards starting January 1, 2027, with the goal of covering over 70% of prior authorization volume by the end of that year. The process will be adopted on a rolling basis, and payers are working to expand the range of services included under the new system. Collaboration with technology companies and feedback from providers will be crucial to achieving widespread adoption.

3. Alignment with Federal Regulations and Provider Collaboration: The initiative aligns with recent federal requirements mandating standardized electronic prior authorization processes for government-sponsored health plans. Success will depend on effective collaboration between payers, providers, and technology partners to ensure seamless integration and robust data exchange. Addressing issues like incomplete documentation and ensuring real-time responses are key priorities to further streamline the process.

Medtronic thwarts cyberattack on its IT systems in wake of data breach at Stryker

By Joseph Keenan – Medtronic, the largest medical device maker in the world, said it contained a cyberattack on its corporate IT systems and that the breach didn’t impact any of its products or patients. The attack is the second in as many months on a medical device maker after Stryker suffered a global cyberattack in early March from the pro-Iran group Hawala Hack in response to the U.S. and Israeli military strikes on the country. That incident left Stryker scrambling for weeks and wiped data from employee electronic devices. The company also reported that some surgeries had to be temporarily postponed due to delivery delays. Read Full Article...

HVBA Article Summary

1. Medtronic's Response and Containment: Medtronic quickly identified and contained the cyberattack on its corporate IT systems, activating incident response protocols and engaging cybersecurity experts. The company emphasized that its IT, product, manufacturing, and distribution networks are kept separate to minimize risk. As a result, there was no reported impact on products or patient safety.

2. Ongoing Investigation and Customer Assurance: Medtronic is currently investigating whether any personal information was accessed during the breach and has committed to notifying affected parties if necessary. The company reassured customers that hospital networks remain separate from Medtronic’s internal systems and are managed by the hospitals’ own IT teams. Medtronic does not expect the incident to affect its business operations or financial results.

3. Industry Context and Recent Cyberattacks: The attack on Medtronic follows a significant cyberattack on Stryker, another major medical device company, which resulted in widespread data loss and operational disruptions. Stryker’s incident was linked to geopolitical tensions and led to postponed surgeries due to delivery delays. These events highlight the increasing cybersecurity threats facing the medical device industry and the importance of robust incident response strategies.

GLP-1 Overdoses on the Rise: Cause for Concern?

By Marilynn Larkin – GLP-1 overdoses have been skyrocketing, with poison centers seeing a nearly 1500% increase in calls related to overdose or side effects of injectable weight-loss drugs since 2019, according to US National Poison Data Center. Between January and April 30, 2025, alone, poison centers managed 3633 GLP-1 related exposure cases. Statewide poison control data, such as California’s, also show upsurges, including overdose cases requiring emergency department treatment — and overdose cases in Washington have doubled since 2024. Experts suggest that the use of compounded drugs has exacerbated the overdose problem. However, increased utilization of GLP-1s and lack of patient education are also among the contributing factors. Read Full Article...

HVBA Article Summary

1. Sharp Increase in GLP-1 Overdose Cases: Poison control centers have reported a dramatic rise in GLP-1-related overdose calls in recent years, with both accidental and intentional overdoses being documented. The surge is attributed to a combination of factors, including greater overall use of GLP-1 medications, the availability of compounded versions, and confusion around dosing schedules. This trend has led to more emergency department visits and heightened concern among healthcare professionals.

2. Dosing Errors and Patient Education Gaps: Many overdose incidents stem from therapeutic errors, such as taking doses too close together, using incorrect amounts from multi-dose vials, or misunderstanding device instructions. Both accidental and intentional overdoses have occurred, sometimes due to patients seeking faster weight loss or supplementing prescriptions from multiple sources. Experts emphasize that clear instructions, thorough counseling, and hands-on demonstration of injection techniques are crucial to preventing these mistakes.

3. Risks and Management of Overdose: The most common symptoms of GLP-1 overdose are gastrointestinal, but hypoglycemia is an underrecognized risk, even in patients not taking insulin or sulfonylureas. There is currently no antidote or standardized observation protocol for acute overdose, so supportive care and prompt consultation with poison control or a medical toxicologist are recommended. Clinicians are encouraged to proactively educate patients about overdose risks, proper storage of medications, and the importance of slow dose titration to minimize harm.