What Do Digital Health Leaders Think of Trump’s New AI Action Plan?

By Katie Adams - The White House released “America’s AI Action Plan” last week, which outlines various federal policy recommendations designed to advance the nation’s status as a leader in international AI diplomacy and security. The plan seeks to cement American AI dominance mainly through deregulation, the expansion of AI infrastructure and a “try-first” culture. Read Full Article…

HVBA Article Summary

1. Pro-Innovation Measures Dominate the Plan: The White House’s AI action plan is heavily focused on accelerating technological progress by removing regulatory barriers and incentivizing infrastructure development. Key elements include deregulation of state and local rules, tax incentives for companies building AI infrastructure, and the creation of regulatory sandboxes for testing emerging technologies. Industry leaders, especially in healthcare, view these measures as beneficial for driving innovation and improving data exchange capabilities across sectors.

2. Experts Raise Concerns Over Missing Safeguards: While the plan is applauded for fostering innovation, experts are concerned about its lack of emphasis on critical safety and ethical considerations. Notably, the plan does not address AI safety protocols, does not mention the Office of the National Coordinator for Health IT (ONC), and overlooks issues like informed patient consent and transparency in AI usage. These omissions are seen as significant gaps that could undermine trust and responsible adoption in high-stakes fields like healthcare.

3. Call for National Standards and Federal Coordination: Industry stakeholders are urging the federal government to establish clear and consistent technical, ethical, and regulatory standards for AI. In the absence of a unified national framework, states have begun implementing their own AI laws, leading to a fragmented and burdensome regulatory environment. Experts argue that a centralized approach is essential to ensure AI systems are interoperable, transparent, and equitably deployed—especially when handling sensitive data and making clinical decisions.

HHS will demo drugmakers' 340B rebate model in limited pilot program

By Dave Muoio - The Trump administration is now accepting applications for a pilot program to demo rebates for 340B drugs that drugmakers have said are necessary to reduce abuse of the decades-old subsidy program. Announced Thursday by the Department for Health and Human Services (HHS) Health Resources and Services Administration (HRSA), the pilot would swap out traditional upfront discounts to providers for an equivalent post-purchase payment coordinated by the drug manufacturer. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Pilot Program for 340B Rebate Model Announced: The Health Resources and Services Administration (HRSA) is launching a pilot rebate model under the 340B Drug Pricing Program, requiring covered entities to submit drug dispensing data within 45 days and receive rebates from manufacturers within 10 days. The pilot, starting January 1, 2026, will initially apply to the 10 drugs selected for Medicare price negotiation.

2. Manufacturers to Bear Administrative Costs and Follow Oversight Protocols: Drugmakers participating in the pilot must cover all IT and administrative costs and are not allowed to deny rebates over concerns of duplicate discounts or diversion, which must instead be raised with the Office of Pharmacy Affairs (OPA). Both covered entities and manufacturers can report rebate-related issues to the OPA.

3. Stakeholder Responses Reflect Divergent Concerns: Hospitals and advocacy groups, such as the American Hospital Association and 340B Health, expressed concern over potential financial burdens and deviation from long-standing 340B operations, while pharmaceutical industry representatives view the pilot as a constructive move toward improving transparency and addressing alleged misuse within the program.

SIIA Government Regulations Update 8.1.2025

By SIIA - Oh, how times – and the news cycles – change. For the better part of 3 months – and virtually every day throughout the month of June – all we heard about in the news was the “One Big Beautiful Bill” (OBBB), and whether Republican House and Senate Leadership could get enough Congressional Republicans to vote YES by President Trump’s July 4th deadline. But now – because all of the news is focused on other attention-grabbing headlines – it’s almost as if the media has forgotten about the OBBB. Read Full Article… 

HVBA Article Summary

1. OBBB Passed Through Both Chambers After Intense Negotiations: The OBBB (likely a budget bill) passed narrowly in both the Senate and the House after significant internal Republican negotiations. In the Senate, 45 amendments were voted on over 26 hours to secure the 50 GOP votes needed before Vice President Vance cast the tie-breaking vote. In the House, 18 Republican holdouts changed their votes after direct engagement from party leaders and President Trump, allowing the bill to pass with 218 votes.

2. Some Key Health Provisions Were Included in the Final Bill:
   The final OBBB included several health-related provisions, such as the permanent extension of the HDHP/telehealth exemption and new allowances for Direct Primary Care Services to be paid with HSA funds—provided they stay within specific cost and service limits. However, not all HSA-related reforms initially proposed made it into the final law.

3. SIIA and Industry Groups Influenced Specific Policy Outcomes: The Self-Insurance Institute of America (SIIA) successfully lobbied against limitations on tax preferences for employer-sponsored health coverage and secured inclusion of some HSA-friendly provisions. It also supported legal action that led to the Supreme Court declining to hear a case, effectively affirming that ERISA preempts certain state pharmacy benefit management (PBM) laws.

Acute care hospitals get a 2.6% raise for 2026

By Susan Morse - Acute care hospitals get a 2.6% payment increase under a final rule released Thursday afternoon by the Centers for Medicare and Medicaid Services. This reflects a projected 2026 hospital market basket percentage increase of 3.3%, reduced by a 0.7 percentage point productivity adjustment. CMS said it has rebased and revised both the Inpatient Prospective Payment System (IPPS) operating and capital market baskets to reflect a 2023 base year. Based on the 2023-based IPPS market basket, CMS is also establishing a national labor‑related share of 66%. Read Full Article…

HVBA Article Summary

1. CMS Projects $5 Billion Increase in Hospital Payments for 2026: The Centers for Medicare & Medicaid Services (CMS) expects hospital payments to rise by approximately $5 billion in 2026, including $2 billion in increased Medicare disproportionate share hospital (DSH) payments and $192 million in new technology add-on payments. Long-term care hospitals (LTCHs) will see a 2.7% payment rate increase, resulting in an estimated $72 million overall rise in payments.

2. AHA Acknowledges Improvements but Flags Ongoing Concerns: The American Hospital Association (AHA) acknowledged the positive changes, including increased DSH support and finalized LTCH payment thresholds, but expressed concern that the updates are insufficient for struggling hospitals, especially in rural and underserved areas. The AHA also criticized the mandatory nature of the new TEAM bundled payment model, urging CMS to make participation voluntary.

3. Regulatory and Program Updates Affect Quality Measures and Payment Models: CMS finalized various changes to hospital quality and value programs, including discontinuing the low-wage index hospital policy, modifying COVID-19 vaccine reporting requirements, and adopting new electronic prior authorization standards. CMS also removed select measures from the Hospital Value-based Purchasing and inpatient quality reporting programs, and will now include Medicare Advantage patients in hospital readmission calculations.

Benefits Think: How the One Big Beautiful Bill will impact telehealth coverage for HDHPs

By Caroline Savello - With the passage of the One Big Beautiful Bill Act, Congress has made permanent the safe harbor allowing high-deductible health plans (HDHPs) to cover telehealth and other remote services before the deductible is met. It may seem like a small technical change in a bill with other large implications for healthcare in the country, but it creates real, practical opportunity, especially for those dealing with high-cost health issues, such as cancer care. As a result, leaders should be rethinking their benefit plans. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Permanent Policy Change Expands Employer Flexibility: A newly established safe harbor provision now allows employers greater flexibility to modify access, availability, and utilization of critical health services. This change is especially meaningful for employees enrolled in high-deductible health plans (HDHPs), as it enables employers to implement more equitable and widespread virtual care strategies that can help close existing gaps in care due to financial and geographic limitations.

2. High-Deductible Plans Can Discourage Early Care: Nearly 50% of private-sector employees are enrolled in HDHPs, where median deductibles of around $2,750 represent a significant portion of typical household savings. As a result, many individuals delay or avoid preventive care such as screenings and follow-ups—not because the services aren’t needed, but because the upfront costs are prohibitive. This trend is particularly concerning for rural populations and others at greater risk of becoming high-cost claimants due to late diagnoses or untreated conditions.

3. Virtual Cancer Care Presents a Scalable Solution: The growing availability of telehealth services makes it possible to deliver essential cancer care remotely—including screenings, risk assessments, symptom monitoring, and nutritional support—without requiring in-person visits. This model not only improves access and consistency across employee populations but also reduces costs for both employers and the healthcare system by eliminating facility expenses and minimizing lost productivity due to travel or time off work.

Cigna battles hospitals' AI billing systems in escalating health care cost fight

By Allison Bell - The artificial intelligence systems that help Cigna manage health care claims for employers are wrestling hard with hospitals' and doctors' AI billing systems. Cigna executives talked about the AI health care cost battles today, during a conference call with securities analysts. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Stop-Loss Claims and Cost Pressures: Cigna reports that while stop-loss claims have surged over the past year, its stop-loss business is currently stable and performing as expected. However, the company acknowledges that healthcare providers are increasingly using advanced technologies to maximize reimbursements, which is contributing to rising cost pressures for employer-sponsored health plans.

2. Strategic Responses and Technology Use: In response to these pressures, Cigna is enhancing its own AI and technology capabilities to better manage provider billing practices and support employers navigating affordability concerns. Employers are increasingly considering more disruptive or cost-effective alternatives, such as self-insured plans, narrower networks, and reducing the use of specialized vendors.

3. Legal and Market Developments: Cigna is actively contesting a new Arkansas law that limits pharmacy ownership by PBMs like its subsidiary, Express Scripts. A federal court has issued a preliminary injunction against the law, citing constitutional concerns. At the same time, Cigna's earnings show steady revenue growth, despite a slight decline in total people covered, with a shift from fully insured to self-insured employer plans.

CVS Health grows revenue 8.4% as Aetna streamlines amid rising healthcare costs

By John Hilton - While competitors continue to struggle with spiraling healthcare costs, Aetna and CVS are celebrating an 8.4% increase in second-quarter revenues. The insurer is achieving this through nimble management and making tough decisions, said David Joyner, president and CEO of CVS Health. In a conference call with Wall Street analysts, Joyner explained how CVS is transforming Aetna via technology. Read Full Article…

HVBA Article Summary

1. Operational Enhancements and Financial Guidance Updates: CVS Health is implementing technology-driven automation and process improvements to enhance service quality and reduce friction for members and healthcare providers. Reflecting some early success, the company raised its 2025 adjusted earnings guidance to $6.30–$6.40 per share, up from a previous range of $6.00–$6.20. However, it also lowered its GAAP earnings forecast without disclosing specific reasons.

2. Regulatory and Market Pressures: CVS is navigating regulatory challenges and market realignment. A government audit revealed $7 million in Medicare Advantage overpayments due to inflated diagnoses, and a federal court ordered its Caremark unit to pay at least $95 million for Medicare overcharges. Additionally, Aetna is exiting the Affordable Care Act exchanges in all 17 states where it currently operates, citing lack of financial sustainability in those markets.

3. Growth in Pharmacy and Weight-Loss Drug Management: CVS’s pharmacy and wellness segment experienced a 12.5% revenue increase year-over-year, driven by higher prescription volumes and drug mix. Meanwhile, the company is actively managing the rising costs of GLP‑1 weight-loss drugs, which now represent a growing share of pharmacy expenses. CVS is adjusting coverage strategies to address affordability while maintaining access, and it continues to promote a broader weight management program that combines medication with lifestyle support for better outcomes.

Data Breach Exposes Most of Allianz Life’s 1.4 Million Customers

By Emily Boyle - Personal data belonging to most of Allianz Life Insurance Co. of North America’s 1.4 million U.S. customers was exposed on July 16, the company confirmed. The breach was discovered one day after a “malicious threat actor” hacked into a third-party customer relationship management system used by the insurer, according to a company statement. Read Full Article…

HVBA Article Summary

1. Data Breach via Social Engineering: Allianz Life disclosed that a threat actor successfully obtained personally identifiable information (PII) related to the majority of its customers, financial professionals, and select employees through a social engineering technique. The company emphasized that, based on their current investigation, there is no evidence that their internal networks or core systems, including the policy administration system, were accessed.

2. Response and Support Measures: In response to the breach, Allianz Life promptly reported the incident to the FBI and took immediate steps to contain the threat. As a precautionary measure, affected individuals will receive 24 months of identity theft restoration and credit monitoring services through Kroll, although the exact number of those impacted has not yet been disclosed.

3. Ongoing Investigation and Communication: Allianz Life noted that its investigation into the breach is ongoing. The company has begun reaching out to affected individuals and is providing dedicated support resources to assist them throughout the process, while continuing efforts to assess and mitigate any potential impact.