Trump Unveils New Health Care Affordability Plan

By Lawrence Wilson – President Donald Trump on Jan. 15 released his administration’s new health care affordability plan, which aims to lower prices through marketplace reforms that include price negotiation, increased competition, and greater price transparency. Trump’s “Great Healthcare Plan” includes actions the administration has already introduced or is working to implement. If codified in federal law rather than being enforced through executive orders and federal regulations, the provisions are expected to carry greater weight and be more likely to last through future administrations. Read Full Article...

HVBA Article Summary

1. Prescription Drug Pricing Reform: The Trump administration’s health care plan includes measures to reduce prescription drug prices by requiring pharmaceutical companies to offer their lowest global prices to U.S. Medicaid patients and sell some drugs directly to consumers. The plan aims to align U.S. drug prices with those in other developed countries and reinvest international revenue back into the U.S. economy.

2. Shift Toward Consumer-Controlled Health Spending: Rather than directing health care subsidies to insurance companies, Trump’s plan proposes sending payments directly to consumers. It promotes alternatives like funded Health Savings Accounts, though such efforts have faced legislative hurdles. The plan contrasts with the Affordable Care Act's insurer-based subsidy structure and is part of broader efforts to improve affordability.

3. Enhanced Health Care Price Transparency: The plan calls for clearer, more accessible information from insurers and providers through a “Plain English Insurance” standard. This includes publishing claims data and average wait times, and requiring Medicare and Medicaid providers to display their pricing. The goal is to empower consumers and large employers to make cost-conscious decisions and encourage competitive pricing.

Kaiser Permanente affiliates to pay $556 million to resolve US claims alleging Medicare fraud

By Jonathan Stempel – The U.S. Department of Justice said five Kaiser Permanente affiliates in California and Colorado agreed to pay $556 million to resolve claims they illegally pressured doctors to add codes for diagnoses they never considered to patients' medical records, in order to inflate Medicare payments from the government. Wednesday's settlement resolves two whistleblower lawsuits accusing the affiliates of Oakland, California-based Kaiser of violating the federal False Claims Act. Read Full Article...

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1. Allegations and Scope of the Kaiser Case: Kaiser and several of its affiliates—including Kaiser Foundation Health Plan, Kaiser Foundation Health Plan of Colorado, Colorado Permanente Medical Group, Permanente Medical Group, and Southern California Permanente Medical Group—were involved in a federal case alleging improper billing practices under Medicare Advantage (Medicare Part C). The U.S. Department of Justice alleged that Kaiser submitted inflated diagnosis codes to secure higher Medicare reimbursements between 2009 and 2018. Kaiser did not immediately respond to requests for comment on the settlement.

2. Improper Diagnosis Coding Practices: The Justice Department asserted that Kaiser engaged in a practice where doctors were directed to "mine" patient medical histories for potential diagnoses that could be added to medical records, whether or not they reflected current conditions. Additionally, bonuses for physicians were allegedly tied to meeting diagnosis coding goals. These practices, according to the DOJ, allowed Kaiser to increase payments from the Centers for Medicare & Medicaid Services by making patients appear sicker on paper than they actually were.

3. Whistleblower Involvement and Financial Outcome: The settlement resolved claims brought by two whistleblowers—Ronda Osinek, a medical coder, and James Taylor, a physician who oversaw risk adjustment and coding programs at Kaiser. Under the False Claims Act, which permits whistleblowers to sue on behalf of the government and receive a portion of any recovery, Osinek and Taylor will receive approximately $95 million. The Justice Department emphasized the broader cost of such fraud, noting that Medicare fraud costs taxpayers billions of dollars annually.

CMS: US' total healthcare spending rose 7.2% to $5.3T in 2024 amid high utilization, coverage

By Dave Muoio – Total U.S. healthcare spending increased an estimated 7.2% to $5.3 trillion in 2024, largely driven by utilization and more complex services as opposed to pricing increases, according to the Centers for Medicare and Medicaid Services actuaries’ annual estimate. The analysis, published Wednesday afternoon in Health Affairs and on CMS’ website, pegs healthcare spending at 18% of the broader economy in 2024, up from 17.7% the year prior. Read Full Article...

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1. Healthcare Spending Growth Outpaced GDP in 2024: In 2024, total U.S. healthcare spending increased by 7.2%, reaching an average of $15,474 per person—up from $14,580 the previous year. This marks the second straight year of significant growth, following a 7.4% rise in 2023, and it notably exceeded the 5.3% growth in the nation’s GDP. According to federal analysts, this kind of back-to-back elevated growth hasn’t been seen since 1991–1992, suggesting a broader post-pandemic shift in healthcare demand and system dynamics.

2. Non-Price Factors Were the Primary Drivers of Spending: Although prices for healthcare services rose by 2.5%, in line with overall economic inflation, most of the spending growth was attributed to non-price factors, such as increased service usage and greater care intensity. These accounted for 3.6% of the growth. Spending increased significantly across key categories: hospital care (8.9%), physician and clinical services (8.1%), and prescription drugs (7.9%), driven by a post-pandemic rebound in demand, including more hospital stays and procedures.

3. Insurance Coverage Remained High Despite Shifts in Enrollment: The insured rate remained robust at 91.8% in 2024, just slightly below the 92.5% peak in 2023. While Medicaid enrollment dropped by 7.9 million due to eligibility redeterminations, private insurance coverage increased by 4.9 million, and the uninsured population rose by 2.8 million. These shifts led to a 16.6% increase in Medicaid spending per enrollee, as those who remained in the program tended to have higher healthcare needs, reflecting a change in the risk profile of the insured population.

Cigna specialty pharmacy faces lawsuit over prices and service concerns

By Allison Bell – Patients and patients' caregivers are suing Accredo Health Group — a Cigna specialty pharmacy business — and other Cigna businesses over allegations that they have been using their market power to drive up patients' share of specialty drug costs and skimp on service. Specialty drugs are very expensive drugs that help patients cope with serious, complicated health problems. Read Full Article... ^{_{(Subscription required)}}

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1. Lawsuit Alleges Service Failures by Accredo: In the case Kimberly Wolf et al. v. Accredo Health Group et al., plaintiffs claim that Accredo repeatedly fails to deliver critical medications on time, forcing some patients to seek emergency care. They also allege that both patients and doctors are required to deal with undertrained customer service representatives, leading to delays and confusion in prescription processing. These concerns are especially significant for patients with serious health conditions who rely on timely access to specialty drugs.

2. Potential Class Action and Growing Legal Focus on Specialty Pharmacies: The plaintiffs are seeking to establish a class action covering all patients who were required by their health plans to use Accredo and either paid for prescriptions or failed to receive medications on time. This case may signal a broader shift in legal attention toward the specialty drug distribution sector, potentially impacting how these services are regulated. For employers, it could help address longstanding concerns about cost and service quality but may also introduce disruptions driven by litigation.

3. Cigna Responds, Denies Claims, and Highlights Patient Care and Choice: Cigna, the parent company of Accredo, strongly denies the allegations, asserting that their teams—including pharmacists, nurses, and care advocates—provide high-quality care to patients with chronic and complex conditions. The company also emphasizes that clients of its pharmacy benefits unit, Express Scripts, have full control over benefit design and are not required to use Accredo exclusively. Cigna has stated its intent to vigorously defend against the lawsuit.

Average US family spent nearly $4K on healthcare in 2024: Report

By Kristin Kuchno – The typical working family in the U.S. spent $3,960 on healthcare-related costs in 2024, including premiums and out-of-pocket expenses, according to a Jan. 13 report from the Center for Economic and Policy Research. The report analyzed 2024 data from the Census Bureau’s Current Population Survey and found a high cost burden among working families, defined as those with at least one worker between the ages of 18 and 64. Read Full Article...

HVBA Article Summary

1. Many Working Families Face High Healthcare Costs: A significant portion of working families are burdened by healthcare expenses. Specifically, 1 in 8 working families spent more than 10% of their income on healthcare. Additionally, 10% of these families paid over $14,800 annually when combining insurance premiums and out-of-pocket costs—highlighting the financial strain even insured families may experience.

2. Healthcare Spending Varies by Income and Education: Lower-income families were more likely to spend a larger share of their income on healthcare. Among families in the bottom income quintile, 22.1% spent at least 10% of their income on healthcare. This trend continued, though slightly less severely, in the second (16.9%) and middle (17%) income quintiles. Conversely, healthcare spending rose with education level in absolute dollar terms—from $1,575 for families with a worker who did not finish high school to $5,700 for families with a worker holding an advanced degree.

3. Rural Households Experience Greater Financial Burden: Geographic location also influenced healthcare affordability. Families living in rural areas faced noticeably higher costs, with 18.8% spending more than 10% of their income on health insurance. This figure exceeds the percentages seen in many income quintiles, indicating that rural residency adds another layer of financial pressure related to healthcare.

CheckMySpot® Earns National Recognition for Transforming Early Skin Cancer Detection at 2025 National Alliance Annual Forum

By CheckMySpot® – On November 11, 2025, CheckMySpot®, the Direct Access Platform™ for early skin cancer detection, was honored during the 2025 National Alliance of Healthcare Purchaser Coalitions Annual Forum Innovator Showcase, where leaders from across the country evaluated breakthrough solutions advancing employer-sponsored healthcare. The National Alliance, a nationwide coalition representing employers, purchasers, and business health coalitions, spotlights innovations that deliver measurable value, improve outcomes, and reduce healthcare spend for over 90 million covered lives. Read Full Article...

HVBA Article Summary

1. Early Detection of Skin Cancer Dramatically Lowers Costs and Saves Lives: Skin cancer affects 1 in 5 Americans, and tragically, two lives are lost every hour in the U.S. due to the disease. Despite being common, skin cancer remains one of the most inefficiently addressed conditions in employer healthcare spending. According to Dr. Joseph Webb, nearly all early-detected skin cancers — including melanoma — can be treated for under $1,000, but delayed diagnosis can push treatment costs above $750,000, often triggering high-cost stop-loss insurance claims. By accelerating early detection, CheckMySpot® aims to prevent these catastrophic outcomes and reduce the severe financial burden for both patients and employers.

2. CheckMySpot® Delivers Proven ROI and Reduces Hidden Employer Costs: Validated by the Validation Institute, CheckMySpot® has demonstrated the ability to reduce annual healthcare claims spend by over 7% for self-funded employers. Beyond direct medical costs, it helps avoid productivity losses due to absenteeism, presenteeism, and disability, which cost U.S. employers an estimated $3.3 billion annually. With healthcare costs and stop-loss premiums rising, timely skin cancer intervention offers employers a high-impact, cost-saving opportunity that addresses one of the most preventable drivers of high-severity claims.

3. Rapid, Accessible Dermatologic Care Benefits Employees, Providers, and Employers Alike: Through a free app, employees can submit two smartphone photos and receive a dermatologist-reviewed assessment in under 24 hours. About 80% of cases require no further action, while suspicious or high-risk lesions are referred to a Preferred Referral network of 260+ dermatology clinics across 30+ states, enabling "front-of-the-line" care that eliminates delays. This model provides employees with zero missed work, no travel, and faster treatment, while also improving care coordination and efficiency for providers. Employers benefit from seamless integration into benefit plans and a modern care pathway that helps close gaps in early detection.

Lifestyle Medicine’s Four Pillars: A Year-End Review

By Neil Skolnick, MD – Today we’re going to do something completely new. Instead of going over a new guideline, we’re going to review some of the most important articles on wellness to come out over the last few years. And to organize our discussion, I’m going to divide up the topic into four different areas, and that is physical activity, nutrition, sleep, and stress. Read Full Article...

HVBA Article Summary

1. Physical Fitness Reduces Mortality Risk, Regardless of Weight: Multiple studies, including a large meta-analysis, show that cardiorespiratory fitness significantly lowers the risk of cardiovascular and all-cause mortality — even in individuals who are overweight or obese. Being unfit, regardless of body weight, doubles or triples mortality risk. Additional studies link higher daily physical activity to lower cancer risk and improved survival in cancer patients, underscoring the health benefits of maintaining physical fitness.

2. Ultraprocessed Foods Are Linked to Higher Health Risks: A growing body of research indicates that higher consumption of ultraprocessed foods is associated with increased risks of cardiovascular disease, diabetes, depression, and all-cause mortality. Some studies report up to a 50–66% increase in disease-specific mortality for heavy consumers. These foods, common in the American diet, are often chemically modified, inexpensive, and heavily marketed, which raises public health concerns.

3. Lifestyle Factors Strongly Influence Cognitive and Physical Health: Evidence suggests that structured exercise, healthy dietary patterns (such as the MIND or Mediterranean diets), adequate sleep, and low stress levels all play significant roles in improving cognitive function, reducing the risk of chronic diseases, and enhancing overall longevity. Social connection also matters — social isolation is associated with a 33% increase in age-adjusted mortality, emphasizing the importance of community and support networks.