Premiums, out-of-pocket costs dominate Americans’ healthcare concerns, survey shows

By Sy Mukherjee – The survey, which polled 25,873 adults from May 4 through May 26, shows that Americans broadly agree high healthcare costs are a bipartisan problem. Premiums were the leading concern among adults, followed by concerns over deductibles, copayments and other costs incurred when receiving care or filling prescriptions. Respondents differed along some party lines over who should solve high health costs, like premiums. Sixty-five percent of Democrats, 49% of Independents and 36% of Republicans said the federal government was the best suited to solve the issue of high premiums, while 40% of Republicans chose insurers compared to 19% of Democrats. Read Full Article...

HVBA Article Summary

1. Cost concerns dominate across groups: The Commonwealth Fund survey reports that respondents most frequently identified insurance premiums and out-of-pocket spending as the leading healthcare system problems. This pattern appears across political affiliations, suggesting the issue is not confined to one party’s voters. The findings also span different insurance situations, including employer coverage, individual or marketplace coverage, and those who are uninsured. The result is a consistent picture of affordability being a central public concern.

2. Views diverge on who should address high costs: While many respondents said the federal government is best positioned to address high healthcare prices, Republicans were more likely than Democrats to point to insurers. This indicates that even when people share the same top problem (affordability), they may disagree about which institutions should lead solutions. The split may shape how receptive different groups are to proposed reforms depending on who is tasked with implementing them. It also suggests that messaging and policy design may need to account for different expectations about responsibility.

3. The survey measures institutional trust, not policy support: The article notes the question focused on which institution is best able to solve the problem, rather than which specific policies respondents favor. Because of that, the results do not show cross-party agreement on particular remedies such as subsidies, price regulation, or benefit design changes. This limitation matters for interpreting the data in political debates, since agreement on the problem does not automatically translate into agreement on solutions. The distinction helps explain how broad concern about costs can coexist with continued disagreement on healthcare policy approaches.

Hospital group pushes value-based care to curb health costs

By Michael Popke – A new blueprint report from the American Hospital Association focuses on value-based health care. "While the U.S. can rightly take pride in having the most advanced health care in the world, that care is increasingly viewed as unaffordable for patients, purchasers, and taxpayers," the association notes in what it calls "A Blueprint to Lower Costs, Improve Access, and Enhance Quality." Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. AHA positions affordability as a system-wide problem: The American Hospital Association argues that U.S. health care is increasingly perceived as unaffordable for patients, purchasers, and taxpayers despite being highly advanced. It attributes continued spending growth to multiple forces, including demographic pressures, technological advances, rising demand for care, and higher input costs for labor, supplies, and prescription drugs. The report also highlights that universal coverage remains unachieved, leaving many people uninsured or underinsured.

2. The blueprint calls for five broad strategies across stakeholders: The report urges a range of stakeholders—such as purchasers, policymakers, technology firms, manufacturers, and individuals—to act on five areas: improving community health, transforming care delivery, reducing administrative waste, lowering drug and device costs, and innovating to improve outcomes. The suggested actions span both clinical changes (like prevention and managing advanced illness) and operational reforms (like standardizing insurance processes and streamlining licensing/credentialing). It also includes policy-oriented ideas touching on pricing transparency and financial protection for patients.

3. Value-based care is framed as an approach, not a single fix: In commentary tied to the blueprint, AHA policy director Robyn Tessin describes value-based care as moving away from disconnected transactions toward coordinated, patient-centered care. She emphasizes that no single payment model will solve every affordability challenge, but stakeholders can expand what is already working. Examples mentioned include strengthening Accountable Care Organizations (ACOs), scaling care coordination innovations, and ensuring financial incentives matter to patients.

Employer use of 'Big 3' PBMs declines - Becker's Payer Issues

By Elizabeth Casolo – Fifty-six percent of employer clients of “Big Three” pharmacy benefit managers — CVS Caremark, Cigna’s Express Scripts and UnitedHealth Group’s Optum Rx — are thinking about switching in the next one to three years. The 2026 “Pulse of the Purchaser” survey, released Aug. 11 by the National Alliance of Healthcare Purchaser Coalitions, included 408 responses from employers. The survey ran in May and June. Read Full Article...

HVBA Article Summary

1. Switching consideration is elevated among major PBM clients: The survey indicates a majority of employers using the “Big Three” PBMs are contemplating a switch within a one- to three-year window. The results suggest dissatisfaction or a reassessment of PBM value among many large PBM customers. The article frames this as part of a broader look at employer purchasing sentiment captured in the “Pulse of the Purchaser” survey.

2. Market share movement away from the Big Three is being driven by smaller employers: The survey reports that the portion of employers relying on the Big Three declined year over year, and that the largest shift came from employers with fewer than 1,000 workers. It also notes that among employers that changed PBMs in the past year, only a minority moved to one of the Big Three. Taken together, these datapoints point to ongoing experimentation with non-Big-Three PBM options, especially among smaller organizations.

3. Cost experience and contract awareness differ between Big Three and other PBMs: The survey findings cited in the article show differences in reported premium experience between Big Three users and employers using other PBMs. It also highlights a gap in contract understanding, with a larger share of Big Three clients reporting they were unaware of what was in their contracts. These differences may be factors employers weigh when evaluating whether to switch PBMs or renegotiate terms.

Four health systems, including Ochsner and Denver Health, go live with Epic's real-time prior authorization checks

By Heather Landi – Four health systems are now using real-time prior authorization checks embedded in the Epic electronic health record, tackling a major pain point for providers. The electronic health record giant collaborated with insurers UnitedHealthcare, Network Health and Aetna to set up the electronic workflows to modernize the manual and time-consuming prior auth process. Epic launched real-time insurance reviews directly into EHR workflows using an industry-standard application programming interface (API) called Coverage Requirements Discovery (CRD). Epic is testing the API with 16 additional payers to support wider industry adoption, the company announced Monday as its annual Users Group Meeting kicks off in Verona, Wisconsin. Read Full Article...

HVBA Article Summary

1. Epic embeds real-time prior-authorization visibility into clinician workflow: The new setup lets providers check, within Epic, whether a service needs prior authorization instead of relying on phone, fax, or separate payer portals. The intent is to reduce duplicative data entry and make requirements clearer at the moment orders are placed. If authorization is not required, care can proceed without waiting for administrative confirmation. If it is required, the process can begin earlier because the requirement is flagged immediately.

2. Early payer-provider collaboration centers on the CRD standard and broader adoption testing: Epic worked with UnitedHealthcare, Network Health and Aetna to implement Coverage Requirements Discovery (CRD) as the initial building block for electronic prior authorization. The article notes Epic is testing the CRD API with 16 additional payers, which suggests a push to expand beyond the first participating insurers. The approach relies on industry standards rather than proprietary connections, aiming for reuse across organizations. Successful scaling still depends on payers supporting the API and provider organizations operationalizing the workflows.

3. Implementation aligns with CMS interoperability policy, but market timelines remain mixed: The article frames real-time prior-authorization APIs as meeting a CMS interoperability mandate scheduled to begin Jan. 1, 2027 for certain payers. It also reports CMS proposed adjusting timing for hospitals by making an electronic prior-authorization measure mandatory starting in calendar year 2028, which could influence provider adoption pace. Epic leadership argues that shipping working integrations now demonstrates feasibility and encourages broader uptake. The company also describes potential future use of AI to interpret payer responses and help determine whether documentation requirements are satisfied.

Why prescription drug prices are plunging

By Courtenay Brown – America is experiencing its biggest prescription drug price deflation in generations. Why it matters: By one important measure, there is a striking reversal underway for one of health care's most stubbornly expensive necessities amid a major Washington push to lower drug costs. Read Full Article...

HVBA Article Summary

1. Drug price deflation is showing up in official inflation data: The article points to Consumer Price Index data showing prescription drug prices falling month over month and year over year. It also notes this is happening even as other health care costs, like hospital and physician services, continue to rise. The piece frames the shift as unusual given prescription drugs’ long-running reputation as a stubbornly expensive category.

2. Policy actions and market forces are both cited as drivers: The Trump administration is credited by its officials for some of the decline, including through the TrumpRx website that highlights discounted cash prices for certain drugs. The article also describes manufacturer moves—such as Eli Lilly and Novo Nordisk agreements affecting GLP-1 drug cash prices and Medicare access—as adding downward pressure. At the same time, a health economist quoted in the story argues many listed discounts already existed and says broader market dynamics are playing a major role.

3. Medicare payment mechanics and negotiations may influence the CPI, but consumer relief is not guaranteed: The article explains that the prescription drug CPI reflects prices pharmacies receive from patients and insurers, including Medicare, rather than only out-of-pocket spending. It also notes that manufacturer rebates paid after transactions are not captured in the index, which can complicate interpretation. Finally, the story emphasizes that falling aggregate prices may not translate into lower copays or easier affordability for patients, given how drug pricing and cost sharing work.

Health insurance keeps 23 million US workers from quitting

By Mark Rosanes – Nearly 23 million American workers remain in jobs they want to leave because they cannot afford to lose their employer-sponsored health coverage, according to figures gathered by the West Health-Gallup Center on Healthcare in America. The share of workers reporting job lock - staying in a job to preserve health insurance - has risen to 24 percent, up eight percentage points from 16 percent in 2021. Read Full Article...

HVBA Article Summary

1. Job lock is measured as both widespread and increasing: The West Health-Gallup Center on Healthcare in America reports that job lock affects a sizable portion of workers who rely on employer-sponsored coverage. The article frames this as a growing issue compared with the prior measurement year cited. The implication is that health coverage is influencing employment decisions and limiting mobility for many workers.

2. Financial pressure is strongly associated with higher job-lock rates: The Gallup-linked findings show job lock is higher among workers facing medical debt, borrowing to pay for care, or describing healthcare costs as a major burden. The article also notes that stress tied to healthcare costs corresponds with even higher reported job lock. These patterns suggest affordability challenges are a key driver behind people staying in jobs for coverage.

3. Chronic conditions and plan design may affect employer risk and renewals: Workers with multiple chronic conditions, as well as certain specific diagnoses, show higher job-lock levels in the reported data. The article connects this to the idea that financially constraining plan designs can concentrate higher-cost members in an employer’s workforce over time. It also links these dynamics to claims trends and employer renewal pricing discussions, alongside employer survey signals that cost reduction has become a leading benefits priority.

Why Are More Young Women Developing Heart Disease?

By Nina Agrawal – The threat of heart disease, and of dying from it, is rising among young women. Recent research has suggested that nearly one-third of all women ages 20 to 44 will have heart disease in 2050, up from one-fourth today. And women under 55 are more likely to die from heart attacks than men under 55. Despite common misconceptions, “heart disease is, in fact, a woman’s disease,” said Dr. Emily Lau, co-director of the Mass General Brigham Women’s Heart Health program. But it is possible to lower the risk. Read Full Article...

HVBA Article Summary

1. Traditional risk factors are increasingly affecting younger women: The article points to obesity, high blood pressure, and diabetes becoming more common at younger ages as a driver of rising heart-disease risk. It also notes research indicating some of these risks can have a stronger impact on women than on men, including diabetes and smoking. Clinicians quoted emphasize the value of routine monitoring to detect risks early. The piece underscores that treatment may involve both lifestyle changes and medications when needed.

2. Sex-specific and reproductive factors can signal higher cardiovascular risk: The story highlights factors such as premature menopause, polyendocrine metabolic ovarian syndrome (previously known as PCOS), pregnancy complications like gestational diabetes and preeclampsia, and inflammatory autoimmune diseases including lupus and rheumatoid arthritis. It notes that these factors are associated with increased heart-disease risk, even if they are not always proven to be directly causal. Physicians describe using these indicators to justify more aggressive management of blood pressure, glucose, and cholesterol. The broader message is that risk assessment in women can require looking beyond standard metrics alone.

3. Additional testing may refine individual risk assessment beyond routine labs: Beyond standard blood work, the article describes the coronary artery calcium (CAC) score from a specialized CT scan as a way to detect calcified plaque before symptoms appear. It also says guidelines recommend checking lipoprotein(a) at least once, with menopause noted as an exception when levels may change and retesting may be appropriate for borderline results. The piece mentions C-reactive protein as a marker of inflammation that may help predict cardiovascular risk, while also noting the evidence is not strong enough for broad recommendations. Overall, the tests are presented as tools to personalize prevention discussions with a clinician.

Patients now shop for doctors like consumers, and the bar just got higher

By Todd Shryock – Patients have stopped giving healthcare providers the benefit of the doubt. Three in four now refuse to book with a doctor rated below 4.0 stars. More than half have already canceled or skipped an appointment because of what they read online — up 15 percentage points in just nine months. And for the first time, AI tools like ChatGPT and Google's AI Overviews influence a patient's choice of provider more than a referral from another physician does. Read Full Article...

HVBA Article Summary

1. Online ratings are becoming a hard gate for patient consideration: The survey describes a “threshold effect” where many patients set a minimum star rating before they will even consider booking. It also reports that healthcare has a higher ratings bar than other business categories cited, widening the gap for practices that are merely “average” online. The article frames this as a structural change in patient behavior rather than a temporary spike in review-checking.

2. Many negative reviews are driven by experience and operations rather than clinical results: The report highlights that complaints often center on how patients are treated and communicated with, including staff interactions and whether patients feel heard by clinicians. It also points to common friction points such as delays and billing as recurring issues that shape online feedback. The article positions reviews as both a marketing signal and an operational diagnostic that can reveal problems before they become larger retention or reputation issues.

3. AI is increasingly shaping discovery and trust, and visibility depends on underlying data and sources: The piece says AI tools are now a leading influence on provider choice, and it breaks down where patients say they place trust on search results pages. It also summarizes research suggesting generative AI citations can favor certain source types (such as hospital rosters and larger, content-heavy organizations), which may disadvantage many independent practices. Separately, it notes that inaccuracies in directories and listings can flow into AI outputs, making consistent, up-to-date practice information a practical competitiveness factor.