The Unholy Matrimony of UnitedHealth with the University of Minnesota is Dangerous for the Future of Health Care

By Dr. Allison Leopold – Last fall, the University of Minnesota Medical School shifted the boundaries of its academic domain and opened its doors to UnitedHealth Group in a partnered launch of a pilot course entitled Leadership and Value. The company is headquartered in Minnetonka, Minnesota, a mere 20-minute drive from the medical school campus. It is the world’s largest health care corporation by revenue, containing two divisions: UnitedHealthcare (health insurance) and Optum (health care services, data, and pharmacy benefit managers). Read Full Article...

HVBA Article Summary

1. Introduction of Industry Partnership in Medical Education: A new elective course for fourth-year medical students was launched as a collaboration between UnitedHealth and a university medical school. Intended to provide insights into health insurance and systems leadership, the course featured a split curriculum: half directed by UnitedHealth and half by university faculty. This partnership marked a notable shift in medical education by embedding corporate viewpoints—particularly around cost-efficiency and "high-value" care—into a traditionally patient-centered training environment.

2. Concerns Over Value-Based Care and Corporate Influence: UnitedHealth's emphasis on "value-based care" was presented as a core principle, encouraging efficient use of health resources and investment in prevention. However, students expressed concern that this model, when administered by a for-profit company, may incentivize withholding necessary treatments to cut costs. Decisions about care are often made by the insurer rather than the physician, raising ethical questions about the potential conflict between clinical needs and shareholder interests.

3. Lack of Critical Counterbalance and Transparency: Although marketed as a balanced course, students found that UnitedHealth's sessions often resembled promotional content and required active questioning to reveal underlying motivations and limitations. Crucial topics such as the company’s legal history, selective data sharing, and ROI-driven equity efforts were not openly addressed. Without structured counterarguments or expert critique, the course risked presenting a one-sided narrative that blurred the line between education and corporate messaging.

Insurers face record fines as states crack down on mental health parity violations

By Kristen Smithberg – Regulators are intensifying enforcement of mental health parity laws, targeting major insurers for violations that leave patients with unequal access to behavioral health care. In Washington, Kaiser Foundation Health Plan of Washington was fined $300,000 for failing to provide sufficient documentation on provider standards and network adequacy, while in Georgia, regulators issued nearly $25 million in fines across 22 insurers following audits that uncovered systemic compliance gaps. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Regulators Are Increasing Parity Enforcement Across the U.S.: States are stepping up enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA), targeting non-quantitative treatment limitations (NQTLs) like prior authorization, network adequacy, and reimbursement. Washington fined Kaiser Foundation Health Plan $300,000, while Georgia issued nearly $25 million in fines across 22 insurers. These actions highlight a nationwide trend of holding insurers accountable for ensuring mental health and substance use disorder coverage is on equal footing with medical and surgical care.

2. Insurers Must Justify How MH/SUD Benefits Are Applied Equally: Health plans must not only follow parity rules but also maintain clear documentation showing how they apply NQTLs, demonstrating that mental health and substance use disorder treatments are not more restrictive than medical treatments. Failure to do so has led to regulatory actions, as seen in Kaiser’s case, where incomplete comparative analyses of utilization management, provider standards, and network adequacy prompted further investigation. In 2021, a major federal and state action resulted in an $18 million settlement with UnitedHealthcare for alleged parity violations — illustrating the financial and reputational risks of non-compliance.

3. Employers and Plan Sponsors Are Now Equally Accountable: Under updated federal guidance, the responsibility for mental health parity compliance extends to both fully insured and self-funded health plans. While carriers may prepare documentation for insured plans, self-funded employers are directly responsible for ensuring comparative analyses are complete, accurate, and defensible. Regulators have clarified that enforcement will apply to any entity unable to provide such documentation upon request. This shift increases pressure on employers and plan sponsors to stay informed and proactive about parity compliance, as failure to do so has already triggered penalties in previous enforcement cases.

New AHIP/BCBSA Survey Shows Nearly 40% of Providers’ Surprise Billing Disputes Are Ineligible Under No Surprises Act

By AHIP – While the No Surprises Act (NSA) continues to protect millions of Americans from unexpected medical bills, new survey data from AHIP and the Blue Cross Blue Shield Association reveals that persistent misuse and inefficiencies in the federal Independent Dispute Resolution (IDR) process are increasing premiums and driving wasteful spending within the health care system. Nearly 40 percent of disputes submitted to IDR in 2024 were identified as ineligible, yet many still advanced through arbitration, ultimately forcing employers and health plans to pay unnecessary and exorbitant claims. Read Full Article...

HVBA Article Summary

1. Ineligible Claims Are Overwhelming the IDR Process and Wasting Billions: The federal Independent Dispute Resolution (IDR) system is facing a surge in claim volume, far exceeding its intended capacity. Originally projected by CMS to handle around 17,000 disputes annually, the system saw over 10 times that amount within months of launch. By 2024, there were nearly 20 million qualified IDR claims, with emergency services accounting for 61%. However, many of these were deemed ineligible by health plans—39% overall, including 45% of non-emergency disputes. These inappropriate submissions have contributed to an estimated $5 billion in wasteful spending, largely due to inefficient processing and legal loopholes.

2. Private Equity-Backed Providers Drive High-Volume, High-Cost Disputes: A small group of providers, often backed by private equity, is responsible for a disproportionate share of IDR claims. These entities, previously associated with the “surprise billing” model, are now allegedly exploiting the arbitration system. On average, arbitration awards through IDR resulted in payments 400% higher than typical contracted rates, with some awards exceeding that margin. Even air ambulance services, which accounted for less than 1% of claims, were disproportionately likely to use IDR due to their high-dollar nature, further contributing to inflated healthcare costs for consumers and employers.

3. Urgent Reforms Needed to Restore Accountability and Reduce Misuse: Policymakers are being urged to address the systemic issues enabling IDR misuse. A key concern is that only 17% of cases flagged as ineligible by health plans were confirmed as such by Independent Dispute Resolution Entities (IDREs), allowing many invalid disputes to result in binding and costly payment determinations. The article calls for eliminating financial incentives for IDREs to process unnecessary claims and enhancing oversight to prevent resubmission of previously resolved or otherwise unlawful disputes. Industry leaders emphasize the need for commonsense reforms to ensure transparency, protect consumers, and rein in premium increases caused by arbitration abuse.

Where ACA subsidies stand: 5 updates

By Jakob Emerson – ACA marketplace enrollment is declining nationally and Congress is struggling to extend the expired subsidies. Five updates on enhanced ACA subsidies: 1. President Donald Trump said Jan. 11 he might veto a bill to extend the subsidies, Bloomberg reported. The House voted Jan. 8 to extend the subsidies for three years, but the measure is not expected to pass in the Senate. A bipartisan group of senators is instead advancing a narrower two-year proposal that would include income limits, minimum monthly premiums and additional guardrails around enrollment. Legislative text could be finalized as soon as this week, but no immediate relief is guaranteed for providers planning for 2026. Read Full Article...

HVBA Article Summary

1. Nationwide Decline in ACA Enrollment: Enrollment in the Affordable Care Act (ACA) marketplace fell to 22.8 million for 2026, representing a 3.4% decrease compared to the same time last year, according to CMS data. New consumer sign-ups dropped by nearly 12%, highlighting a significant decline in engagement and potential barriers to access or affordability.

2. Significant State-Level Enrollment Drops and Responses: Individual states are reporting sharp enrollment declines, with Pennsylvania losing around 1,000 enrollees each day. In response to the downturn, Illinois, Connecticut, and Pennsylvania have extended their open enrollment deadlines in an effort to boost participation and stabilize their marketplaces.

3. Policy Interventions and Economic Concerns: With federal subsidies expired, some states have stepped in to offer relief. Massachusetts is investing an additional $250 million to offset premium hikes for residents, while New Mexico has achieved record enrollment after implementing its own subsidy replacement. Healthcare leaders warn this shift could increase emergency department usage and uncompensated care, with a prior analysis forecasting a $57 billion economic impact and the loss of 286,000 jobs, including 130,000 in healthcare.

Wegovy and similar weight-loss drugs may not 'pay for themselves'

By Allison Bell – Wegovy and other weight-loss drugs that contain GLP-1 agonists may make the employer health plan participants who take the drugs look and feel better, but the drugs probably won't improve the participants' health enough to offset the cost of the drugs. Coady Wing, an Indiana University economist, and three colleagues have reported that finding in a working paper posted on the website of the National Bureau of Economic Research. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. GLP-1 Agonists Did Not Reduce Overall Health Plan Spending Over Five Years: Based on data from 750,000 health plan participants between 2016 and 2023, employer-sponsored insurance plans spent an average of $22,000 per patient on GLP-1 agonist drugs over a five-year period. Despite the high cost, the study found no evidence of overall savings in total plan expenditures for those patients. In fact, there was an average increase of approximately $6,800 per patient, primarily due to higher outpatient care costs associated with treatment and monitoring.

2. Study Focused on General Population, Not High-Risk Patients: The researchers emphasized that their analysis included relatively healthy individuals in the general population, rather than high-risk patients with serious preexisting conditions. This distinction may explain the lack of significant cost offsets, as healthier patients typically have lower baseline healthcare spending. The study also considered not just drug and inpatient costs, but outpatient monitoring expenses, which may have further contributed to the increase in spending.

3. Long-Term or Future Cost Benefits Remain Possible, Especially for Higher-Risk Groups: While this study did not find cost savings over five years, the authors note that future GLP-1 drugs or longer-term usage may lead to better financial outcomes, particularly among patients with obesity or diabetes, who tend to have higher initial healthcare costs. Previous research, such as a University of Chicago study from March 2025, estimated that semaglutide could become cost-effective at under $100,000 per quality-adjusted life year if its price dropped to $1,522 per year. Thus, potential long-term benefits remain an open question, especially for more medically complex patient populations.

Why chronic health management benefits boost employee retention

By Lee Hafner – Benefit leaders are well aware of the healthcare costs associated with chronic conditions such as diabetes and hypertension, but what about the toll on retention and engagement? For example, the American Diabetes Association reports that, on top of the $307 billion spent on medical costs for diabetes care in 2022, indirect economic costs including absenteeism, loss of productivity and inability to work due to disease-related disability tacked on more than $100 billion. Around 34 million people currently have type 2 diabetes, with numbers expected to rise substantially by 2050, according to the CDC. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Integrated Health Benefits Improve Outcomes: Comprehensive care platforms that unify services like primary care, mental health, dietitians, labs, pharmacies, and 24/7 communication access can lead to better employee health and reduced employer healthcare costs. By streamlining preventive and treatment services into a single, coordinated system, companies can minimize gaps in care, reduce the need for time off work, and help prevent chronic conditions from being overlooked or unmanaged.

2. Employee Education Is Crucial for Utilization: In the absence of a fully integrated care model, employers can still support health outcomes by proactively communicating the full range of benefits available. Clear, intentional messaging about the importance of routine checkups and chronic disease management empowers employees to make informed decisions about their health. Tailored education efforts and easy access to program information can significantly increase engagement with available resources.

3. Leadership Engagement Drives Health Culture: When organizational leaders openly prioritize and normalize preventive care—by attending their own appointments and encouraging others to do the same—they help establish a workplace culture that values wellness. This top-down support signals to employees that their health is a priority, which can improve morale, increase productivity, and support long-term employee retention by reducing both illness and presenteeism.

Exercise Matches Therapy in Easing Depression Symptoms

By Megan Brooks – Exercise can reduce symptoms of depression in adults to a similar degree as established psychological therapies and may offer comparable benefits to antidepressant medication, according to an updated Cochrane review of randomized trials. Across a large and diverse evidence base, exercise produced a moderate reduction in depressive symptoms compared with no treatment or control conditions, while showing little-to-no difference in efficacy when directly compared with psychotherapy or pharmacotherapy, although certainty varied by comparison and outcome. Read Full Article...

HVBA Article Summary

1. Exercise as a Safe and Accessible Option for Depression Management: A comprehensive review of 73 randomized controlled trials involving nearly 5000 adults found that exercise can moderately reduce depressive symptoms when compared to no treatment or control interventions. Exercise offers advantages such as low cost, broad physical health benefits, and fewer adverse events—typically mild musculoskeletal issues—compared to the more frequent gastrointestinal and fatigue-related side effects of antidepressants. However, the overall certainty of the evidence was low, and long-term effects remain uncertain due to limited follow-up.

2. Comparable Effectiveness to Therapy and Medication with Fewer Side Effects: The analysis found little-to-no difference in short-term outcomes when comparing exercise to psychotherapy or antidepressant medications. Specifically, exercise was about as effective as these established treatments in reducing depressive symptoms, though the evidence varied in certainty. Experts note that while this supports exercise as a viable treatment component, decisions about using it alone or in combination should be tailored to individual needs in consultation with healthcare providers.

3. Limitations in Study Quality and Real-World Applicability: Despite rigorous methodology in selecting studies, many included trials had small sample sizes and methodological flaws, which weaken the strength of conclusions. Moreover, most exercise interventions studied were structured and supervised, often involving motivated participants, which limits the generalizability of results. Experts caution against viewing exercise as a replacement for traditional care, recommending it instead as a complementary strategy, while calling for more high-quality, pragmatic studies to better inform clinical guidance.