DOGE sets sights on Medicaid: New York Times

By Alan Condon - President Donald Trump's Department of Government Efficiency, led by Elon Musk, aims to reduce federal spending by $1 trillion, with Medicaid emerging as a likely target, The New York Times reported Feb. 3. Read Full Article…

HVBA Article Summary

1. DOGE Team's Influence on Federal Payments: Led by Steve Davis, Mr. Musk's DOGE team has sought access to CMS and Treasury Department payment systems, aiming to scrutinize federal spending and eliminate "fraudulent payments." This initiative aligns with broader efforts to reduce improper payments, which totaled $236 billion in fiscal 2023.

2. Impact on Medicaid and Healthcare Providers: Hospitals and health systems, particularly those reliant on Medicaid reimbursements, are concerned about financial instability as DOGE’s cost-cutting approach may lead to abrupt funding changes. Medicaid and ACA subsidies remain vulnerable, with potential policy shifts affecting reimbursement structures, patient coverage, and hospital financial planning.

3. Legislative and Policy Uncertainty: While major Medicaid overhauls require congressional approval, Republican-backed proposals such as spending caps and stricter enrollment requirements could significantly reduce federal funding. With ACA tax credits set to expire in 2025, healthcare providers must prepare for potential increases in uninsured rates and rising costs.

RFK Jr. clears first HHS nomination hurdle

By Madeline Ashley and Erica Carbajal - The Senate Finance Committee voted 14-13 along party lines on Feb. 4 to approve Robert F. Kennedy Jr.'s HHS secretary nomination. His nomination now goes to the full Senate floor, where he needs 51 votes for a confirmation. Read Full Article…

HVBA Article Summary

1. Committee Opposition and Key Vote: All 13 Democrats on the Senate Finance Committee voted against Mr. Kennedy’s nomination, while Sen. Bill Cassidy, MD, R-La., was seen as a pivotal vote due to his concerns over Mr. Kennedy’s past vaccine skepticism.

2. Cassidy’s Decision and Administration Commitments: Dr. Cassidy ultimately supported Mr. Kennedy after intense discussions with both him and the White House, citing serious commitments from the administration on shared priorities like healthy foods and a pro-American agenda.

3. Healthcare Policy Scrutiny: During his confirmation hearings, Mr. Kennedy faced tough questioning on his healthcare positions, including Medicare and Medicaid, his vaccine stance, and his broader Make America Healthy Again agenda aimed at reducing chronic disease.

Rising cancer rates among young adults: Why employers must prioritize preventive care

By Stephen Horvat - The number one driver of health care costs in the United States is chronic conditions like cancer. With cancer rates rising among young adults, employers face mounting challenges in managing health care costs while ensuring employee wellbeing. Read Full Article…  ^{_{(Subscription required)}} 

HVBA Article Summary

1. Bridging the Cancer Screening Gap: Many adults aged 18 to 49 fall outside the recommended cancer screening guidelines, leaving them vulnerable to late-stage diagnoses. Employers can play a crucial role in addressing this gap by implementing proactive preventive care programs and educating employees on early detection.

2. Financial and Health Impacts of Late-Stage Diagnoses: Rising cancer rates among young adults are driving up healthcare costs, with treatment expenses expected to surpass $240 billion by 2030. Early detection reduces financial strain on both employees and employers by lowering high-cost claims and ensuring less invasive treatment options.

3. Implementing Preventive Health Strategies: Organizations can foster a culture of health by introducing phased, mandatory screenings and leveraging incentive structures to encourage participation. Self-funded plans should focus on removing cost barriers and designing cost-neutral preventive programs to maximize long-term health and financial benefits.

Cigna links executive pay to customer satisfaction as insurers face scrutiny

By Sriparna Roy - U.S. health insurer Cigna Group (CI.N) will hire more staff in people-facing roles and link executive compensation to customer satisfaction as part of sweeping measures to address widespread criticism over medical care denials and delays. Read Full Article…

HVBA Article Summary

1. Customer Frustration and Industry Response: The killing of Brian Thompson has intensified public anger towards health insurers, prompting major companies like Cigna and UnitedHealth to take measures aimed at restoring trust, including policy changes and enhanced customer support.

2. Cigna’s Strategic Adjustments: In response to customer dissatisfaction, Cigna is implementing concierge teams to assist with prior authorization and claims issues, doubling staff for patient support, expanding digital communication for physicians, and planning an annual transparency report on claims resolution.

3. UnitedHealth’s Policy Reforms: UnitedHealth has pledged to collaborate with policymakers to reduce prior authorization requirements for Medicare patients, signaling a broader industry shift toward streamlining healthcare access and addressing consumer concerns.

Your Frequently Asked Questions Regarding Current Federal Telehealth Policy

By CCHP - Last month in partnership with the National Consortium of Telehealth Resource Centers (NCTRC), the Center for Connected Health Policy (CCHP) held a webinar on federal telehealth policy for 2025. During the hour-long webinar, over 100 questions were asked, and due to such a high number, CCHP was unable to answer all the questions before the webinar concluded.  As a telehealth resource center, CCHP is charged with providing one-to-one technical assistance and regularly fields questions from the public regarding telehealth policy. Read Full Article…

HVBA Article Summary

1. Medicare Telehealth Waivers Extended Through March 31, 2025: The passage of HR 10545 in December 2024 extended several telehealth waivers, allowing Medicare beneficiaries continued access to audio-only telehealth, telehealth services from Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), and delaying in-person visit requirements for mental health services. However, the CMS 2025 Physician Fee Schedule (PFS) introduced changes, including the deletion of audio-only CPT codes 99441-99443, creating uncertainty around billing practices.

2. Confusion Around Audio-Only Billing and Permanent Telehealth Policy: While Congressional action allowed continued use of audio-only telehealth through March 2025, CMS proposed a more permanent expansion, albeit with statutory limitations. Providers seeking clarity on billing were informed by CMS that codes 99202-99215 could be used with specific modifiers (Modifier 93 for non-FQHC/RHC providers and Modifier FQ for FQHC/RHC providers). However, the 2025 Medicare Telehealth Services List lacks explicit notation on which services can be delivered via audio-only, raising concerns about potential billing complexities post-March 2025.

3. Potential Telehealth Policy Changes After March 31, 2025: If no further extensions are made, Medicare telehealth reimbursement policies will revert to pre-pandemic rules starting April 1, 2025. This could reintroduce geographic and site limitations, restrict audio-only services, and reinstate in-person visit requirements for mental health telehealth services. Additionally, new AMA telehealth CPT codes (98000-98016) were not adopted by Medicare, with the exception of 98016. Medicaid and private insurers may adopt different policies, creating further variability in reimbursement.

To Protect Against Alzheimer’s, Researchers Look to Weight Loss Drugs

By Dana G. Smith and Dani Blum - Over a decade ago, a smattering of studies suggested that early cousins of drugs like Ozempic and Mounjaro could prevent, or even reverse, signs of Alzheimer’s disease in mice. Now, as the next generation of these medications has soared in popularity, and scientists discover they may have wide-ranging health benefits, research is revving up to investigate whether the drugs that upended diabetes and obesity care could also revolutionize Alzheimer’s treatment. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Encouraging Early Findings with Caveats: Preliminary research suggests that diabetes and weight loss drugs like semaglutide may reduce the risk of Alzheimer’s disease, with some studies indicating a 40-70% lower likelihood of diagnosis. However, these observational studies cannot confirm causation, and the modest benefits seen in clinical trials leave uncertainty about their real-world impact.

2. Potential Mechanisms of Action: Scientists theorize that these drugs may protect against neurodegeneration by improving metabolic health, reducing brain inflammation, and enhancing insulin signaling. Some evidence from animal studies suggests they could also reduce tau protein buildup, a key factor in Alzheimer’s progression.

3. Need for Further Research: While the initial data is promising, experts emphasize that more rigorous clinical trials are necessary to confirm the effectiveness of these drugs for preventing or treating Alzheimer’s. Understanding how they interact with the brain and whether they can meaningfully alter disease progression remains an open question.

Trust in government health agencies continues to erode, often along partisan lines

By Alan Goforth - The decline in public trust in U.S. government health agencies that began during the pandemic continues as the nation transitions to a new administration and Congress. Although large shares of adults continue to trust their own doctors to make the right recommendations when it comes to health issues, this number also has decreased. Read Full Article…  ^{_{(Subscription required)}} 

HVBA Article Summary

1. Declining Trust in Public Health Agencies: Trust in major U.S. health agencies, including the CDC, FDA, and state and local public health officials, has declined significantly. While 61% of Americans still trust the CDC “a great deal” or “a fair amount,” this is a slight drop from 66% in June 2023. Trust in the FDA and state and local public health officials saw even sharper declines of over 10 percentage points.

2. Partisan Divide in Trust and Vaccine Attitudes: Political differences continue to shape trust in government health agencies, with Democrats significantly more likely than Republicans to trust agencies like HHS, CDC, and FDA. Additionally, skepticism toward vaccines appears to be growing among Republicans and parents, with 40% of Republicans now believing the false claim that COVID-19 vaccines have caused more deaths than the virus itself.

3. Public Perception of Pandemic Preparedness: Despite concerns about trust in public health institutions, opinions on the government's pandemic preparedness are mixed. While 4 in 10 adults believe the U.S. is more prepared for another pandemic than in 2020, one-quarter think it is less prepared, and one-third believe it remains the same. Concerns about a potential H5N1 bird flu outbreak remain moderate, with 44% expressing some level of concern.

FDA OKs First-In-Class Nonopioid Pain Med Suzetrigine

By Megan Brooks - The US Food and Drug Administration (FDA) has approved suzetrigine 50 mg tablets (Journavx, Vertex Pharmaceuticals), a first-in-class nonopioid analgesic for treatment of adults with moderate-to-severe acute pain. Suzetrigine selectively inhibits the NaV1.8 pain-signaling pathway in the peripheral nervous system, a validated target for peripheral pain management. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Non-Opioid Pain Relief Innovation: Suzetrigine is a novel nonopioid analgesic that blocks peripheral pain signals without affecting the brain, reducing addiction risk and central nervous system side effects. It provides effective pain relief without sedation or dependence, addressing a critical need for safer acute pain treatments.

2. FDA Expedited Approval – The FDA granted suzetrigine priority review, fast-track, and breakthrough therapy designations due to its potential to reduce opioid reliance. Its approval marks a major milestone in pain management, offering a safer alternative while mitigating addiction and overdose risks.

3. Clinical Efficacy and Cost – Phase 3 trials showed suzetrigine significantly reduced pain compared to placebo, with rapid onset and sustained relief. It was well tolerated, with common side effects including itching and muscle spasms. It is contraindicated with strong CYP3A inhibitors, and patients should avoid grapefruit. The wholesale acquisition cost is $15.50 per 50-mg pill.