NYPD: A 'strong person of interest' in UnitedHealthcare CEO's death arrested in Pennsylvania

By Paige Minemyer - The New York Police Department confirmed that there is a man in custody in central Pennsylvania in connection with the shooting death of UnitedHealthcare CEO Brian Thompson. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Apprehension in Pennsylvania: Luigi Mangione, a 26-year-old Maryland native, was apprehended at a McDonald's in Altoona, Pennsylvania, after being recognized by a restaurant worker from photos released by the NYPD. He was found with a gun believed to match the weapon used in the crime, fake identification cards, and a handwritten manifesto expressing animosity toward corporate America.

2. Evidence and Investigation: Authorities recovered a ghost gun, possibly 3D-printed and capable of firing 9 mm rounds, which were used in the killing of Brian Thompson. Detectives are piecing together Mangione's movements, including his travel to Pennsylvania via Greyhound bus. The manifesto reportedly included statements suggesting the shooting was premeditated and ideologically motivated.

3. Legal Proceedings and Police Efforts: Mangione faces murder charges in New York and additional gun charges in Pennsylvania. NYPD detectives and Manhattan district attorney representatives are in Altoona for further questioning. Police credit the release of suspect photos for breaking the case, while UnitedHealth Group expressed condolences to Thompson’s family and gratitude to law enforcement.

The Big 3 PBMs are Countersuing the FTC. Does Their Argument Have Any Teeth?

By Marissa Plescia - CVS Caremark, Express Scripts and Optum Rx are fighting back. After the FTC filed a lawsuit in September, accusing the three major pharmacy benefit managers of engaging in anticompetitive rebating practices tied to insulin, the defendants have turned plaintiff. In November, they countersued the agency, claiming its lawsuit is unconstitutional. Read Full Article…

HVBA Article Summary

1. The PBMs' Counterarguments and Legal Tactics: The PBMs argue that the FTC's administrative proceedings are unconstitutional, citing issues such as lack of impartiality, protection of Commissioners and administrative judges from removal, and violation of due process. They claim these proceedings unfairly favor the FTC and aim to reshape an entire industry through enforcement, rather than judicial oversight. This countersuit is viewed by experts as a potential delay tactic aimed at slowing regulatory action and pushing the case to more favorable judicial venues.

2. FTC’s Case Against PBMs and Alleged Market Practices: The FTC accuses PBMs of anti-competitive practices, including maintaining restrictive drug formularies and prioritizing higher-priced drugs for larger rebates. These practices allegedly increase medication costs for patients while benefiting PBMs financially. The complaint highlights significant influence over the pharmaceutical supply chain, with the "big three" PBMs controlling 80% of the U.S. prescription market and contributing to inflated drug prices.

3. Broader Implications and Political Context: The outcome of this legal battle remains uncertain, with potential Supreme Court involvement due to its conservative tilt. Experts suggest that while the case might challenge the FTC’s structure, it aligns with the agency's mission to protect consumers and promote competition. Political dynamics, including changes in administration or FTC leadership, could influence the trajectory, but bipartisan concern over healthcare costs ensures continued scrutiny of PBM practices.

View of U.S. Healthcare Quality Declines to 24-Year Low

By Megan Brenan - Americans' positive rating of the quality of healthcare in the U.S. is now at its lowest point in Gallup’s trend dating back to 2001. The current 44% of U.S. adults who say the quality of healthcare is excellent (11%) or good (33%) is down by a total of 10 percentage points since 2020 after steadily eroding each year.  Read Full Article… 

HVBA Article Summary

1. Declining Ratings of U.S. Healthcare Quality and Coverage: Between 2001 and 2020, majorities positively rated U.S. healthcare quality, but this has shifted significantly, with 54% now considering it only fair or poor. Similarly, healthcare coverage evaluations remain low, with just 28% rating it as excellent or good, reflecting a continued decline from earlier high points like 41% in 2012.

2. Cost and Access Dominate Public Concerns: The high cost of healthcare continues to be the most pressing health issue for Americans, with 23% citing it as the top problem. Satisfaction with healthcare costs remains exceptionally low, with only 19% expressing contentment, highlighting persistent systemic dissatisfaction.

3. Contrasting Personal Experiences with Broader Perceptions: Despite widespread negativity about the U.S. healthcare system, most Americans rate their own healthcare positively. Currently, 71% view their healthcare quality as excellent or good, and 65% feel the same about their coverage, underscoring a stark contrast between individual satisfaction and systemic concerns.

Employers brace for rising health care costs and political changes in the New Year

By Michael Popke - With a tumultuous year in health benefits news nearing its end, Business Group on Health has identified rising health care costs, the need for greater vendor accountability and the impending impact of the 2024 election as among the top health and wellbeing trends to watch in 2025. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Historic Health Care Cost Increases Demand Employer Action: Employers are facing unprecedented health care cost increases, with projections for 2025 exceeding trends of the past decade. In response, organizations will prioritize cost management, affordability, quality, and outcomes. This may involve reevaluating long-standing partnerships and exploring disruptive strategies to mitigate costs while enhancing patient experiences.

2. Heightened Accountability for Vendor Partnerships: Employers are set to demand greater accountability from vendor partners in 2025, emphasizing transparency and measurable outcomes. Data-driven decision-making will be central, with employers considering alternative models like direct contracting with centers of excellence, value-based provider networks, and innovative copayment structures to improve affordability and quality.

3. Impact of Evolving U.S. Health Policy: Anticipated changes in U.S. policy, driven by shifts in federal leadership, will significantly influence employer health strategies. Key areas of focus include maintaining the tax-free status of employer-sponsored health plans, ensuring consistent national coverage through ERISA protections, and enhancing vendor accountability through greater transparency and fiduciary control.

Blue Cross' $2.8 bln health provider settlement wins judge's preliminary approval

By Mike Scarcella - A U.S. judge has tentatively approved Blue Cross Blue Shield’s plan to pay $2.8 billion and adopt new business practices to resolve claims by hospitals, physicians and other professionals that they were underpaid for reimbursements. Read Full Article…

HVBA Article Summary

1. Historic Antitrust Settlement: Chief U.S. District Judge R. David Proctor described the monetary award as "extraordinary" and a landmark step in a case alleging Blue Cross Blue Shield and affiliates violated antitrust laws by dividing the U.S. into exclusive regions, limiting competition, inflating insurance costs, and suppressing provider reimbursements. The settlement includes transformative changes aimed at improving health insurance transparency, efficiency, and accountability.

2. Broad Impacts on Healthcare Providers and Insurers: The $2.7 billion settlement builds on a previous 2020 resolution for individual and commercial subscribers, with additional provisions requiring Blue Cross to implement a cloud-based platform for claims verification and tracking. This technology-driven reform addresses long-standing grievances from healthcare providers about reimbursement processes.

3. Legal Challenges and Pending Approval: While the settlement represents a significant milestone in resolving the 12-year-long litigation, concerns have been raised by out-of-network emergency services providers over unresolved reimbursement claims in Virginia and Florida. Opponents to the settlement can challenge it before the final fairness hearing scheduled for July 16, 2025.

ICHRA adoption surges 29% in 2024

By Lucy Peterson - Since the Individual Coverage Health Reimbursement Arrangement, or ICHRA, first became available in 2020, its popularity and adoption have grown rapidly. According to a new report shared by Remodel Health, in partnership with PeopleKeep, ICHRA adoption grew by 29% from 2023 to 2024 alone. Read Full Article…

HVBA Article Summary

1. Widespread Adoption Across Industries and Geographies: The ICHRA model is gaining traction across diverse industries and states, demonstrating its adaptability and appeal to both small businesses and large employers. Notable industries with high adoption rates include automotive, non-profits, and food and beverage, especially among larger employers. Geographically, states such as Arkansas, Maryland, and Wisconsin show high adoption rates for organizations with over 100 employees, while smaller organizations in 12 states, including Alabama and Alaska, report 100% adoption.

2. Flexibility and Tailored Benefits for All Employer Sizes: ICHRA adoption shows a near-even split between small employers and Applicable Large Employers (ALEs). The flexibility of ICHRA allows businesses, regardless of size, to offer tailored health benefits. Smaller organizations often exceed ALEs in average contributions, highlighting the model's scalability and appeal for varied workforce needs. For example, non-ALEs average contributions of $600 compared to $448 for ALEs.

3. Higher Contributions in Specialized Industries and High-Cost Regions: Industries with higher wage earners, such as engineering, dentistry, and real estate, report ICHRA contributions exceeding $750, with some reaching $1,126. Geographically, higher cost-of-living states, including the District of Columbia and New York, report contributions of over $1,000, while lower cost-of-living states like Kentucky and Indiana see contributions under $500. This data underscores ICHRA’s flexibility in aligning with both regional economic conditions and industry-specific needs.

GLP-1s Boost IBD Outcomes in Patients With T2D and Obesity

By Shrabasti Bhattacharya - The use of glucagon-like peptide 1 (GLP-1) receptor agonists is associated with a reduced risk for poor inflammatory bowel disease (IBD)–related outcomes in patients with both IBD and type 2 diabetes (T2D), specifically in those with obesity. Read Full Article…

HVBA Article Summary

1. Key Findings: The study found that GLP-1 use was linked to a 26% lower risk of poor composite IBD-related outcomes in patients with T2D and IBD, with benefits observed in both ulcerative colitis (29% reduction) and Crohn's disease (22% reduction). Hospitalization risks were also lower in patients with ulcerative colitis but not in those with Crohn’s disease.

2. Subgroup Insights: Obese patients with IBD experienced significant benefits from GLP-1 treatment, with reduced risks for adverse composite outcomes by 39% in the full cohort, 37% in the UC group, and 40% in the CD group. However, these benefits were not evident in patients without obesity.

3. Clinical Implications and Limitations: GLP-1 analogs show potential as a treatment for obesity-associated IBD, expanding their role beyond current indications. However, the study's limitations, such as lack of data on disease location, endoscopic findings, and medication adherence, highlight the need for further research, especially in younger populations.