After UnitedHealthcare CEO killing, healthcare industry faces a new security reality

By Shelby Livingston - The cold-blooded shooting death of UnitedHealthcare CEO Brian Thompson on Wednesday sent shockwaves through corporate America, highlighting the threats increasingly faced by healthcare executives and workers, and prompting companies to rethink the measures they take to keep their top brass safe. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Increased Threats to Corporate Leaders: Threats against executives, especially in the healthcare industry, are becoming more frequent due to the emotional nature of their work, such as decisions on patient care and insurance coverage. Social media amplifies these threats, with public backlash often escalating after high-profile incidents like Thompson’s murder.

2. Rising Demand for Executive Security Services: The recent tragedy has sparked a surge in corporate inquiries about executive protection. Companies are exploring measures ranging from personal security details and home security upgrades to dark web monitoring, reflecting a growing awareness of the risks facing business leaders.

3. Varied Security Practices Among Companies: While some companies, like Pfizer and Dexcom, provide extensive security arrangements for their CEOs in response to specific threats, many executives still operate without personal security. High costs and evolving perceptions of risk contribute to the variability in how organizations approach executive safety.

2024 In Review: State Telehealth Policy – Legislative Roundup

By CCHP - As 2024 draws to a close, the Center for Connected Health Policy (CCHP) is releasing its annual roundup of state telehealth legislation. This year, state legislatures continued to refine, expand, and impose new standards on telehealth, responding to evolving needs in healthcare delivery and leveraging lessons learned from the COVID-19 pandemic. Read Full Article…

HVBA Article Summary

1. Increased Legislative Focus on Telehealth: In 2024, 41 states and the District of Columbia introduced telehealth-related legislation, resulting in 176 enacted bills, reflecting a steady but growing interest in telehealth policy. Significant increases were observed in cross-state licensing laws, while Medicaid and private payer telehealth reimbursement policies remained stable compared to 2023, ensuring broader access and standardized care across states.

2. Expansion of Medicaid and Private Payer Reimbursement Policies: States continued to broaden Medicaid reimbursement for telehealth, adding services like speech therapy and behavioral health care, and addressing technologies such as remote patient monitoring and continuous glucose monitoring. Private payer legislation maintained a focus on parity, requiring coverage and reimbursement for telehealth services equivalent to in-person care, as seen in states like Michigan and Connecticut.

3. Streamlined Licensing and Professional Standards: Efforts to ease cross-state telehealth licensing saw a notable rise, with states enacting compacts and creating telehealth-specific registration processes to enhance access while maintaining oversight. Additionally, professional practice requirements were clarified, ensuring that telehealth remains a high-quality care option for diverse healthcare professions, including behavioral health, physical therapy, and even veterinary services.

How America Compares: Older Adults and Coverage without Care

By Laura Beerman  - High cost-sharing is making it hard for many older U.S. adults to afford needed healthcare. This is compared to other countries and despite having Medicare or Medicare Advantage (MA) coverage. The result is skipped and delayed care — from recommended tests to treatment to follow-up.  Read Full Article… 

HVBA Article Summary

1. High Out-of-Pocket Costs Lead to Skipped or Delayed Care: Nearly 25% of older U.S. adults spent over $2,000 in out-of-pocket healthcare costs last year. This financial burden contributes to the highest rates of skipped or delayed care among high-income nations, particularly in dental and prescription drug services.

2. Coverage Without Care Reflects Systemic Gaps: Despite having Medicare or Medicare Advantage, many older Americans face significant cost-related access challenges. These include not visiting doctors, skipping medical tests, or forgoing medications, which can lead to poorer health outcomes and increased long-term costs.

3. Solutions Require Domestic and International Insights: Proposed remedies include adopting international practices like capping out-of-pocket expenses and fully covering essential services. Domestically, the Inflation Reduction Act addresses prescription drug costs with measures like insulin copayment caps and price negotiations, though broader improvements to Medicare and MA programs remain necessary.

Healthcare industry needs to get a grip on AI governance in 2025, ECRI warns

By Emma Beavins - Risks with AI-enabled health technologies topped the list of the ECRI Institute's annual ranking of health technology hazards. Also topping the list are lack of technical support for medical device use in the home, cybersecurity threats from third-party vendors and substandard or fraudulent medical devices supplied by unauthorized distributors. Read Full Article…

HVBA Article Summary

1. AI Governance and Risks: While AI offers significant potential benefits in healthcare, such as cost savings and advanced decision support, ECRI emphasizes the need for strong governance to address risks like algorithmic bias, hallucinations, and model drift. Trusting AI without scrutinizing its output could lead to inappropriate patient care decisions. Smaller healthcare facilities may face challenges in implementing robust AI oversight due to limited resources, potentially widening disparities in healthcare technology adoption.

2. Homecare Device Complexity: ECRI highlights the risks associated with the use of complex medical devices in homecare settings, especially for hospital-at-home programs and chronic condition management. Issues like improper device setup, insufficient training for patients and caregivers, and physical or structural limitations in home environments can compromise patient safety. Healthcare organizations should ensure usability for nonclinical users and provide comprehensive training and support for homecare patients.

3. Cybersecurity Threats and Vendor Risks: Cybersecurity ranks high on ECRI's list of healthcare hazards, citing examples like the February 2024 cyberattack on Change Healthcare. Dependence on third-party vendors for critical functions such as revenue cycle management and electronic health records can expose healthcare organizations to significant risks, including service disruptions and data breaches. ECRI advises thorough vetting of vendors and proactive assessment of security vulnerabilities to mitigate these risks.

ICHRAs can simplify health benefits for SMBs while reducing costs

By Alan Goforth - Most entrepreneurs start businesses because they are passionate about their product or service, not necessarily to crunch numbers or manage people. But as their business grows, they must deal with the challenge of providing an attractive benefits package that will help recruit and retain talented workers. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Simplifying Health Benefits for Small Businesses: Small business owners often find managing health benefits overwhelming and time-consuming. Individual Coverage Health Reimbursement Arrangements (ICHRAs) provide a solution by enabling employers to offer tax-deductible reimbursements for employees' individual health insurance premiums, giving employees the freedom to select plans that fit their needs while reducing administrative burdens for employers.

2. The Growing Popularity of ICHRAs: Since their introduction in 2020, ICHRAs have steadily gained traction, with 500,000 people now utilizing these benefits as of 2024, according to the HRA Council. Notably, 83% of employers offering ICHRAs previously did not provide health coverage, underscoring their role in bridging the gap for small businesses unable to afford traditional employer-sponsored plans.

3. StretchDollar's Expansion and Market Impact: With $6 million in new funding led by Fika Ventures and Oscar Health, StretchDollar aims to further enhance its self-service platform, empowering small businesses to manage employee benefits more effectively. This expansion highlights the importance of innovative solutions to address the healthcare challenges faced by over 50% of small businesses unable to offer traditional health insurance.

Priority Health closes on purchase of Indiana payer

By Jakob Emerson - Priority Health has closed on its purchase Physicians Health Plan of Northern Indiana, a Fort Wayne-based payer with more than 50,000 members in Indiana and Ohio. Read Full Article…

HVBA Article Summary

1. Announcement Timeline: The acquisition was initially announced in June, with updates provided in a Dec. 3 news release, although the financial terms of the deal remain undisclosed.

2. Priority Health Overview: As the payer arm of Corewell Health, Priority Health operates out of Grand Rapids, Michigan, and provides insurance services to over 1.3 million members.

3. Membership Coverage: Priority Health's offerings span multiple plan types, including commercial, Medicare, and Medicaid plans, showcasing its diverse reach and role in healthcare coverage.

Legislators urge DOJ to investigate PBMs for potential role in opioid epidemic

By Paige Minemyer - A group of legislators is calling on the Department of Justice to dig into whether pharmacy benefit managers played a role in the opioid epidemic. Read Full Article…

HVBA Article Summary

1. Alleged Collusion in Opioid Crisis: Four bipartisan representatives have called on the Department of Justice to investigate allegations that the three largest pharmacy benefit managers (PBMs)—CVS Caremark, Express Scripts, and Optum Rx—colluded to steer patients toward OxyContin prescriptions. According to confidential reports, the PBMs reportedly received $400 million in rebates and fees from Purdue Pharma in exchange for this activity, as detailed in an October article in Barron's.

2. Rebate Practices and Consumer Impact: The letter accuses PBMs of pocketing rebates and fees from Purdue Pharma instead of passing savings on to consumers, exacerbating the opioid crisis. Beyond the opioid issue, the representatives criticize the broader lack of transparency in PBM rebate agreements and formulary decisions, arguing these practices operate with minimal oversight and harm public health.

3. Broader Scrutiny of PBMs: The representatives highlight additional concerns about PBMs' vertical integration with large health insurers, group purchasing organizations, and pharmacies, which has drawn widespread criticism from policymakers seeking industry reform. This letter adds to mounting legal and regulatory challenges faced by PBMs, including a Federal Trade Commission lawsuit alleging price-rigging in the insulin market, which PBMs have strongly denied in a countersuit.