Trump fires HHS inspector general: 4 notes

By Rylee Wilson - HHS Inspector General Christi Grimm was one of more than a dozen federal watchdogs fired by President Donald Trump, ABC News reported Jan. 26. Read Full Article…

HVBA Article Summary

1. Mass Dismissal of Inspectors General: Former President Trump fired inspectors general from at least 15 federal agencies, including key oversight officials at the Defense, State, Labor, and Veterans Affairs Departments, citing the need for new appointees and alleging some were not performing their duties effectively.

2. Legal and Ethical Concerns: The firings may have violated federal law, which requires a 30-day notice to Congress for the dismissal of Senate-confirmed inspectors general. The Council of the Inspectors General on Integrity and Efficiency questioned the legality of these actions, emphasizing the threat to oversight independence.

3. Impact on Government Oversight: The removals raised concerns about the independence and effectiveness of government watchdogs, particularly in agencies like HHS' Office of Inspector General (OIG), which plays a crucial role in monitoring Medicare and Medicaid, recovering billions in funds, and preventing fraud and waste.

UnitedHealth hikes number of Change cyberattack breach victims to 190 million

By Emily Olsen - The vast majority of the 190 million affected individuals have already been notified, either through individual letters or through the substitute notice published on the company’s website. Data exposed could include contact information, health insurance details, health information and billing and claims data, according to the notice. Read Full Article… 

HVBA Article Summary

1. Massive Data Breach Impact: The cyberattack on Change Healthcare may have exposed the personal data of approximately 190 million Americans, significantly surpassing earlier estimates and making it the largest healthcare data breach ever reported.

2. Financial and Operational Fallout: UnitedHealth spent $3.1 billion responding to the attack, while healthcare providers faced severe disruptions in billing, insurance verification, and reimbursement, prompting emergency financial assistance programs.

3. Regulatory and Security Concerns: Lawmakers and regulators have raised alarms over the breach’s implications for patient privacy and industry cybersecurity, with UnitedHealth’s final tally of affected individuals still pending official confirmation with HHS.

Health Care Analyst’s Focus is to Make Employers an Offer They Can’t Refuse

By Wendell Potter - Employers are overwhelmed by hundreds of so-called “point solutions” designed to lower the cost of their employee health benefits and improve clinical outcomes. But that era is giving way to a new world order in which collaboration will be the driving factor that disrupts the status quo. That’s the principal takeaway from my recent conversation with Brian Klepper, a highly regarded health care analyst who is CEO of Proven Health. Read Full Article…

HVBA Article Summary

1. Revolutionizing Employer Healthcare Strategies: Klepper's approach focuses on identifying and vetting top-performing healthcare organizations that consistently deliver better outcomes at lower costs. His method emphasizes high-value niches such as chronic disease management, musculoskeletal care, maternity, pharmaceuticals, and surgery—areas that consume the bulk of healthcare spending.

2. Scaling High-Impact Healthcare Solutions: Despite proven success in improving health outcomes and reducing costs, scaling these innovations remains challenging due to the entrenched fee-for-service model. Klepper envisions a shift where vetted organizations collaborate under a single contractual framework, integrating advanced primary care and value-based risk management to deliver cost-effective healthcare.

3. Empowering Employers to Demand Change: Klepper highlights the critical role of employers in reshaping the healthcare system, urging them to leverage their collective purchasing power to demand better services. He advocates for making employer healthcare deals so compelling that ignoring them would have career consequences for benefits managers, thereby disrupting conventional practices and driving systemic reform.

What Trump's busy first week means for healthcare: AI policy shifts, HHS comms blackout, patient protections and more

By Fierce Healthcare Staff, Dave Muoio, Noah Tong, Emma Beavins, and Anastassia Gliadkovskaya - President Donald Trump made good on his campaign promises to kick off his second term in office with a tidal wave of executive orders. Either in front of cheering supporters at a Monday evening rally or later that night in the Oval Office, Trump signed dozens of executive orders and outlined other presidential actions spanning large swaths of the federal government. Read Full Article…

HVBA Article Summary

1. Regulatory and Policy Overhaul: President Trump revoked 78 executive actions from the Biden administration, issued new orders affecting agency rulemaking, and implemented a regulatory freeze that halts healthcare policy changes for 60 days. This includes a review of proposed rules related to HIPAA security and telehealth prescribing, while certain finalized regulations are stalled.

2. Healthcare and Public Health Shifts: Key Biden-era healthcare initiatives were rescinded, including AI safety guardrails, drug pricing models, and diversity, equity, and inclusion (DEI) policies. The administration also removed discrimination protections for gender identity and sexual orientation, withdrew federal funding for abortion-related services, and terminated public health communication channels like the CDC’s Morbidity and Mortality Weekly Report.

3. Immigration and Workforce Changes: The Trump administration ended the "sensitive locations" policy, allowing immigration enforcement in hospitals, places of worship, and schools. A federal hiring freeze was enacted, and senior executive service officials deemed non-compliant with administration priorities face potential dismissal. Additionally, the administration withdrew from the World Health Organization (WHO) and reinstated the Mexico City Policy restricting abortion funding abroad.

Insurers Failed to Comply With Mental Health Coverage Law, Department of Labor Report Finds

By Duaa Eldeib, Maya Miller, Annie Waldman, and Max Blau - The U.S. Department of Labor found widespread noncompliance and violations of federal law in how health plans and insurers cover mental health care, findings that mirror a recent ProPublica investigation. Read Full Article… 

HVBA Article Summary

1. Widespread Exclusion of Key Behavioral Treatments and Ghost Networks: The report reveals that health plans and insurers have systematically excluded crucial behavioral treatments, such as therapies for substance use and autism, while also maintaining inadequate mental health provider networks. Secret shopper surveys uncovered that many listed providers were unreachable, contributing to “ghost networks” that hinder patients from receiving necessary care.

2. Regulatory Challenges and Enforcement Struggles: Despite ongoing enforcement efforts, federal agencies, particularly the Department of Labor, continue to face significant challenges in holding insurers accountable for mental health coverage violations. Investigators have worked to address issues affecting over 7 million people but remain understaffed, with one investigator overseeing nearly 14,000 plans. The agency has repeatedly sought additional funding, warning that budget shortfalls could severely impact enforcement capabilities.

3. Concerns Over Insurers’ Use of Biased Medical Reviews: Insurance companies, including UnitedHealth, Cigna, and Blue Cross Blue Shield, have been found to rely on doctors whose coverage denials have been criticized by courts. Investigations have revealed cases where doctors selectively interpreted medical evidence to justify denials, sometimes leading to tragic outcomes. The Department of Labor is now probing the oversight and management of these doctors, aiming to ensure fairness and impartiality in coverage decisions.

Wisconsin Quality Collaborative CEO Describes ‘Secret Sauce’ to Group’s Success

By David Raths - The Wisconsin Collaborative for Healthcare Quality (WCHQ) is a member-led consortium comprised of health systems representing 75 percent of the patients in the state. The members work to improve the quality and cost-effectiveness of healthcare through the public reporting of comparative performance information. Read Full Article…

HVBA Article Summary

1. WCHQ’s Founding and Evolution: Originally a pioneering initiative among Wisconsin health systems, WCHQ was formed to measure and publicly report healthcare quality with physician-driven data. Over 20 years, it has grown from reporting on diabetes care to a comprehensive quality improvement organization with a statewide impact.

2. Data-Driven Quality Improvement: WCHQ operates a unique patient-level data repository, allowing member health systems to track and enhance care quality efficiently. It has expanded beyond simple reporting to proactive practice transformation, leveraging real-time data to address disparities and improve healthcare value.

3. Future Directions and Integration: As WCHQ looks to 2025, it aims to deepen its role within member organizations, transitioning from a data provider to an integral part of their quality departments. This shift is essential to maintaining healthcare quality despite financial pressures and ongoing industry transformations.

Oklahoma takes CVS Caremark to new PBM court over alleged underpayments

By Brendan Pierson - Oklahoma's attorney general has accused CVS's (CVS.N), Caremark pharmacy benefit manager unit of under-reimbursing pharmacies for prescription drugs. Read Full Article…

HVBA Article Summary

1. Landmark Enforcement Action Against PBMs: Oklahoma Attorney General Gentner Drummond has filed the first-ever administrative law case against a pharmacy benefit manager (PBM), Caremark, under a new enforcement procedure established in November 2023. The complaint alleges that Caremark underpaid 15 independent Oklahoma pharmacies for 200 prescriptions, violating state law.

2. Legal and Financial Ramifications for PBMs: Oklahoma law allows the state to seek restitution for underpaid pharmacies, impose fines of up to $10,000 per violation, and revoke a PBM’s operating license. The case underscores increasing scrutiny on PBMs, which act as intermediaries in drug pricing and reimbursement negotiations.

3. Broader Regulatory Crackdown on PBMs: The lawsuit is part of a broader trend of state and federal actions against PBMs, with all 50 states enacting laws targeting their practices since 2017. The FTC has also reported that the three largest PBMs—Caremark, Optum, and Express Scripts—generated $7.3 billion in revenue by marking up drug prices, further fueling regulatory concerns.

Does easy access to 'Obamacare' premium subsidies hurt employer plans?

By Allison Bell - Affordable Care Act opponents hope employers will help them make "Obamacare" health insurance premium subsidies harder to get. Chris Jacobs, a Paragon Health Institute analyst, argues in a new report on health care cost-cutting ideas that one simple way to reduce federal government health care spending would be to let the current, broad eligibility rules for individual health insurance premium tax credit subsidies expire, rather than renewing the current rules. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Expiration of Enhanced ACA Subsidies and Potential Employer Coverage Impact: The expanded ACA premium tax credit eligibility, which significantly increased enrollment in ACA exchange plans, is set to expire on December 31. Analysts argue that allowing these subsidies to lapse could save billions for federal taxpayers while preventing a reduction in employer-sponsored health coverage. The Congressional Budget Office projects that extending these subsidies permanently could lead to a 3.5 million decrease in employer plan enrollment due to a shift toward government-subsidized plans.

2. Debate Over the Effectiveness of ACA Coverage and Industry Benefits: Critics, such as Jacobs, claim that the ACA’s expanded subsidies primarily benefit hospitals and insurers rather than improving health outcomes for uninsured individuals. He argues that many previously uninsured people already had access to basic care through charity and emergency services. Meanwhile, health industry stakeholders strongly support extending the subsidies, as they generate increased revenue while insulating consumers from rising premiums.

3. Political and Legislative Uncertainty Surrounding ACA Subsidies: The future of the enhanced ACA subsidies depends on political dynamics, including Trump’s policy direction and congressional negotiations. While Republicans have criticized ACA programs, they may hesitate to repeal them without a replacement. In key states like Florida, where millions rely on ACA coverage, potential subsidy cuts could pressure lawmakers to maintain or modify the program to prevent widespread coverage losses.