Employers lobby to keep health care prices transparent in hopes of containing costs

By Julie Appleby - It seems simple: Require hospitals and insurers to post their negotiated prices for most health care services and — bingo — competition follows, yielding lower costs for consumers. But nearly four years after the first Trump administration's regulations forced hospitals to post massive amounts of pricing information online, the effect on patients' costs is unclear. Read Full Article… 

HVBA Article Summary

1. Legislative Challenges and Bipartisan Support: Despite bipartisan agreement on price transparency in healthcare, efforts to codify hospital and insurer price transparency rules into federal law before a potential Trump administration return have failed. This leaves the existing regulations vulnerable to legal and political changes, with proponents vowing to continue lobbying Congress.

2. Mixed Impact of Price Transparency Rules: The introduction of price transparency has revealed significant cost variations across hospitals and insurers but has shown limited measurable impact on consumer behavior or healthcare costs. While some high-cost services saw slight price reductions, other tiers experienced increases, suggesting potential competitive adjustments among providers and insurers.

3. Compliance and Usability Concerns: Federal audits and advocacy group findings indicate low compliance rates among hospitals with price transparency requirements. Additionally, while insurer-provided cost calculators offer tailored cost estimates for some consumers, the overall data remains difficult for uninsured individuals or those without access to calculators to navigate effectively.

Trump opposition to House spending package threatens PBM rebate measure

By Allison Bell - A big, "must pass" House package that includes new rules for employers' pharmacy benefit managers has stalled. House leaders posted a copy of the 1,547-page "Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025" package, which was negotiated by House Speaker Mike Johnson, R-La., on the web Tuesday. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Political Dynamics and Legislative Challenges: Former President Donald Trump criticized the absence of a debt ceiling increase in the proposed spending package, warning Republicans against passing such legislation. Meanwhile, House Republicans face internal discord over the process for drafting the package, and Democrats show little interest in supporting a revised version. The latest proposal, the "American Relief Act of 2024," failed to secure enough bipartisan support to suspend House rules and advance quickly.

2. PBM Provisions and Health Care Transparency: The "Further Continuing Appropriations" package included provisions requiring pharmacy benefit managers (PBMs) to disclose detailed drug pricing data and pass discounts to employer-sponsored health plans. Experts and industry leaders, such as Dr. Wayne Winegarden and Danny Sanchez, praised these measures for promoting transparency and addressing self-dealing practices. These provisions, however, remain absent from the newer American Relief Act draft.

3. Implications for Federal Programs and Potential Shutdown: The original appropriations package sought to stabilize Medicare funding, extend support programs for the elderly, and address national security concerns. Without passing a spending package by Friday, parts of the government could shut down. Congress may revisit the PBM provisions in future legislation, as the measures have broad bipartisan support and align with long-standing political goals of improving pharmaceutical industry accountability.

U.S. healthcare spending up 7.5%, nears $5T

By John Commins - The nation's healthcare expenditures hit $4.9 trillion in 2023, increasing by 7.5%, up sharply from recent post-COVID annual expenditures and rising to $14,570 per person, federal actuaries reported Wednesday. The analysis by the Office of the Actuary at the Centers for Medicare and Medicaid Services, published online Wednesday in Health Affairs, showed that growth in 2023 was markedly higher than the post-COVID 4.6% rate of growth in 2022, and 4.6% in 2021, but also well below the 10.6% growth in 2020 when the coronavirus pandemic raged. Read Full Article…

HVBA Article Summary

1. Rising Healthcare Spending Across Sectors: Total healthcare spending grew significantly in 2023, with private health insurance spending increasing by 11.5% to $1.5 trillion and Medicare spending reaching $1 trillion, up 8.1%. Medicaid spending saw a slower growth rate of 7.9%, totaling $871.7 billion. Out-of-pocket spending rose by 7.2% to $505.7 billion, driven by hospital care and clinical services.

2. Growth Driven by Enrollment and Service Utilization: Increased enrollment in Marketplace and employer-sponsored plans contributed to private insurance growth. Medicare Advantage spending rose sharply, accounting for 52% of Medicare expenditures. Medicaid enrollment stabilized at 91.7 million amid resumed eligibility re-determination. The use and intensity of healthcare services across hospitals, physicians, and outpatient care accelerated growth across multiple sectors.

3. Spending Shifts in Key Categories: Hospital care experienced the fastest growth since 1990, rising 10.4% to $1.5 trillion, while spending on retail prescription drugs jumped 11.4% to $449.7 billion, largely due to treatments for diabetes and obesity. Physician and clinical services also saw a notable increase, growing 7.4% to $978 billion.

I Was a Health Insurance Executive. What I Saw Made Me Quit.

By Wendell Potter - I left my job as a health insurance executive at Cigna after a crisis of conscience. It began in 2005, during a meeting convened by the chief executive to brief department heads on the company’s latest strategy: “consumerism.”  Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. The Rise of "Consumerism" in Healthcare: Marketing campaigns in the late 1990s and early 2000s promoted "consumerism" in healthcare, advocating for high-deductible plans under the guise that patients with more financial responsibility would make cost-effective decisions. While the strategy promised to curb rising premiums, it ultimately shifted significant costs onto consumers, leaving many underinsured and saddled with medical debt.

2. The Human Toll of High-Deductible Plans: Firsthand encounters with the effects of inadequate insurance coverage, such as patients seeking care in makeshift clinics due to unaffordable out-of-pocket costs, highlighted the devastating consequences of high-deductible plans. These encounters underscored the disparity between the promises of consumer-driven healthcare and the harsh realities faced by millions, particularly those with chronic or serious illnesses.

3. Profit-Driven Priorities in Health Insurance: The health insurance industry’s focus on shareholder profits often comes at the expense of patient care. Practices such as aggressive prior authorizations, denial of necessary treatments, and cost-cutting measures have increased barriers to healthcare access, with tragic outcomes like the preventable death of Nataline Sarkisyan serving as stark reminders of the system's failures.

4 ways to use AI in employee benefits, plus 3 drawbacks

By Carolyn Heinze - AI can potentially help streamline employee benefits administration, including guiding employees through complex programs. However, using AI for benefits can also potentially lead to issues such as compromised employee privacy and integration problems. Read Full Article…

HVBA Article Summary

1. Efficient Automation with AI: AI can significantly streamline employee benefits administration by answering common questions, personalizing benefits suggestions, reducing costs through predictive analytics, and enhancing the employee experience. For instance, chatbots can save HR staff time, and AI-driven recommendations can help employees choose cost-effective plans.

2. Balancing AI and Human Empathy: While AI excels at handling data-driven tasks, certain scenarios, such as managing family emergencies or sensitive leave requests, require the empathy and judgment of human HR professionals. This ensures personalized, compassionate responses during critical moments.

3. Addressing AI Risks in HR: Companies must address potential issues with AI, such as data privacy, poor system integration, and over-reliance on technology. Organizations should prioritize robust security protocols, seamless integration with existing tools, and maintaining a "human touch" for situations that demand emotional intelligence.

Who wins the battle between payers and providers?

By Alan Goforth - When health plans and providers battle over payment, no one wins -- and patients are caught in the crossfire. No relief appears to be in sight as payer-provider relations have become more contentious in an era of rising denials and significant financial pressures, including a rate of inflation that, in some instances, outpaces growth in reimbursement. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Tension in Payer-Provider Relationships: Nearly 60% of healthcare finance leaders report a negative shift in payer-provider relationships over the past three years, driven by a focus on rates rather than collaborative strategies to optimize value in healthcare.

2. Strategies for Strengthening Partnerships: HFMA suggests practical measures to improve payer-provider relationships, such as assuming positive intent, being selective with contracts, holding monthly joint meetings, and fostering transparency. Building value-based models with shared risk is key to fostering a spirit of collaboration.

3. The Need for Long-Term Solutions: Experts like Dr. Sachin H. Jain emphasize the importance of deeper, intentional partnerships to achieve better health and financial outcomes. Strategies like early-term investments and tenure arrangements with providers can support co-designed healthcare solutions and mitigate crises.

Employee loneliness may affect performance and turnover at work

By Carolyn Crist - Loneliness in the workplace leads to lower job performance, decreased job satisfaction and increased turnover, according to a Dec. 10 report from the Integrated Benefits Institute. About 13% of the workforce said they experience loneliness, which can show up as social isolation from colleagues. In addition, 27% reported clinically relevant anxiety, and 20% reported clinically relevant depression. Read Full Article…

HVBA Article Summary

1. Loneliness and Mental Health: IBI's research underscores the profound connection between loneliness and mental health challenges, revealing that those experiencing frequent loneliness are over seven times more likely to suffer from anxiety or depression. This critical public health concern also extends to workplace dynamics, where affected employees face increased sick days and higher prevalence of chronic conditions.

2. Workplace and Family Stressors: Parents of children with mental health needs face heightened risks, with a 92% increased likelihood of experiencing anxiety or depression and a 77% rise in loneliness. Overbooked schedules and ineffective workplace setups further exacerbate loneliness, highlighting the need for intentional policies to foster connection and balance.

3. Solutions and Social Support: Workers with robust social support experience a 91% reduction in loneliness. Employers can address these challenges by implementing comprehensive strategies focused on flexible work arrangements, fostering psychological safety, and promoting effective communication and work-life balance to combat loneliness and enhance employee well-being.

GLP-1s May Cut Risk for Late-Onset Epilepsy

By Pauline Anderson - Newer glucose-lowering drugs reduce the risk for late-onset seizures and epilepsy by 24%, with glucagon-like peptide 1 receptor agonists (GLP-1 RAs) cutting the risk by 33%, according to a new meta-analysis. Read Full Article…

HVBA Article Summary

1. Promising Reduction in Epilepsy and Seizure Risk: The meta-analysis revealed that glucose-lowering drugs, including GLP-1 RAs, DPP-4 inhibitors, and SGLT2 inhibitors, reduced the combined risk of epilepsy and seizures by 24% (RR, 0.76; 95% CI, 0.62-0.95). Among the drug classes, GLP-1 RAs showed the most significant reduction in seizure risk (RR, 0.67; 95% CI, 0.46-0.98), suggesting potential anti-epileptogenic effects.

2. Potential Mechanisms and Clinical Implications: These drugs likely exert their effects through cerebrovascular improvements and reductions in neuroinflammation, key factors in preventing epilepsy in older adults with cerebrovascular and neurodegenerative conditions. While this evidence is encouraging, clinicians are advised to cautiously consider these medications for patients with cerebrovascular risk factors until further research confirms these findings.

3. Call for Rigorous Prospective Studies: Experts, including Dr. Daniel Goldenholz, emphasized the need for prospective, long-term studies to better define epilepsy development and monitor outcomes over extended periods. Such research would help solidify the findings and guide potential clinical applications of these glucose-lowering drugs in epilepsy prevention.