UnitedHealth employs 4% of primary care physicians

By Allison Bell - Optum — an arm of UnitedHealth — employed about 6,170 of the 239,138 primary care physicians who billed Medicare in 2023, or 4% of the total, according to a new Health Affairs Scholar paper. Affiliates of UnitedHealth and other large insurers employed about 6.8% of the physicians who billed Medicare. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Scope and Methodology: The research team analyzed Medicare program data to examine trends in vertical integration within primary care. Although they did not include data from commercial insurers, the findings are still broadly representative, as Medicare is accepted by approximately 98% of U.S. physicians, making it a strong proxy for national primary care patterns.

2. Debate on Vertical Integration: There is ongoing debate over the effects of vertical integration between health insurers and providers. Proponents argue that such deals can lead to lower premiums, better preventive services, and enhanced coordination of care. On the other hand, critics, including some policymakers, warn that these mergers may reduce competition, limit patient options, and give large insurers excessive market power.

3. Call for Further Research: While the study does not directly assess how vertical integration influences the cost, availability, or quality of primary care, the authors stress the importance of further investigation. They recommend that policymakers and researchers explore how such integration may affect competition, pricing, and patient access in local health care markets.

Are There Any Healthcare Wins Hidden Inside the One Big Beautiful Bill Act? Yes, a Few…

By Katie Adams - When President Donald Trump signed the One Big Beautiful Bill Act into law earlier this month, the reaction from healthcare groups was overwhelmingly negative. The law slashed Medicaid spending by hundreds of billions of dollars over the next decade and eliminated Affordable Care Act subsidies. Read Full Article…

HVBA Article Summary

1. Mixed Impact on Healthcare Access and Costs: The legislation is expected to increase uncompensated care costs, which experts say could accelerate hospital closures and reduce access to care—especially in rural and underserved communities. This concern stems largely from the bill’s failure to extend Affordable Care Act tax credits and to maintain Medicaid coverage for vulnerable populations.

2. Permanent Telehealth Expansion Offers Stability and Cost Relief: A major provision of the law permanently allows first-dollar coverage for telehealth under high-deductible health plans. This change removes a financial barrier to care for millions of insured Americans, encourages earlier and more preventive treatment, and provides critical access to specialists in rural areas where healthcare infrastructure is rapidly deteriorating.

3. New Incentives for Employers, Manufacturers, and Pharma: The legislation introduces several measures aimed at strengthening the healthcare sector through market-driven innovation. These include giving employers more flexibility in health benefit design via tools like ICHRAs, offering significant tax breaks for domestic medical manufacturers and pharmaceutical companies, and exempting orphan drugs from federal price negotiation—steps that could promote investment, expand access, and foster innovation.

Doctors could see 3.8% Medicare pay bump in 2026

By Maya Goldman - Doctors could see up to a 3.8% increase to their Medicare payments next year under a Trump administration proposal released Monday. The big picture: Physicians have seen their fees decline for years, with Congress usually stepping in at the last minute to avert scheduled cuts or make them whole. Read Full Article…

HVBA Article Summary

1. Physician Payment Adjustments Tied to Value-Based Care Models: Starting in 2026, physicians who participate in qualifying alternative payment models that emphasize patient outcomes are set to receive a 3.8% increase in Medicare payments. Those who do not participate in such models will receive a slightly lower increase of 3.3%. These figures include a 2.5% temporary increase approved by Congress in a recent tax and spending bill, signaling a continued push toward value-based care incentives.

2. Shift Away from AMA-Driven Survey Data in Payment Calculations: The Centers for Medicare and Medicaid Services (CMS) is proposing a major change in how Medicare payments are calculated by moving away from survey data collected by the American Medical Association. Instead, CMS would rely on actuarial data that incorporates five years of medical practice cost inflation. This shift is expected to reduce payments by 2.5% for codes not tied to physician time and aims to create more accurate and equitable valuations across different medical services.

3. Impact on Medical Specialties and Broader System Reform Calls: Under the proposed changes, specialties that bill primarily for time-based services—such as family medicine, geriatrics, and psychiatry—may see payment increases, while procedure-heavy specialties like radiology and radiation oncology could face reductions. While some policy advocates view these changes as a step toward correcting underinvestment in primary care, many healthcare leaders argue that the current Medicare reimbursement model remains outdated and misaligned with broader goals of high-value, preventive care.

How tech is changing the benefits advisor-client relationship

By Andrea Dumont - As technology becomes more embedded in HR decision-making, benefits advisors are becoming more central to the client experience. What was once a transactional relationship centered on plan selection and insurance products is now a strategic partnership rooted in business guidance, data and technology. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. HR leaders increasingly seek strategic advisors, not just brokers: Employers are moving beyond the need for basic benefits comparisons and are looking for advisors who can understand and support their broader organizational goals. This includes navigating workforce retention, digital transformation, and integrating complex HR systems. As a result, 88% of employers are considering consolidating their technology, consulting, and broking needs with a single trusted advisor within the next five years.

2. Data and AI are transforming the advisor role: With the growing use of integrated HCM platforms, benefits advisors now have access to a wealth of real-time employee data across multiple functions like payroll, engagement, and onboarding. When combined with AI tools, this data allows advisors to move from reactive support to proactive strategy—spotting trends, surfacing opportunities, and helping clients make informed, future-focused decisions.

3. Formalizing advisory services strengthens client relationships: Today’s clients expect more than transactional support; they want a partner who offers structured guidance and long-term value. Advisors who formalize their services—such as offering tech implementation support, compliance audits, or strategic planning sessions—can differentiate themselves from competitors and establish deeper, more trusted relationships with clients.

Benefits Think: Legal wellness benefits are becoming a must have offering

By Megan Berki - As the workforce evolves, organizations must recommit to designing wellness offerings that provide security, stability, and peace of mind. Designing health and wellness programs focused on physical and mental health has always been an essential factor in the overall health and success of the workforce. We are now witnessing another important factor emerge: Legal wellness. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Holistic Wellness Now Includes Legal Health: Employers are broadening their definition of employee well-being to include legal wellness, recognizing that traditional health and financial benefits alone are no longer sufficient. This shift aligns with a more proactive workforce that values legal preparedness—such as estate planning, will creation, and real estate transactions—as essential to long-term stability. Legal issues are increasingly seen as integral to overall wellness, not just personal concerns.

2. Legal Stress Significantly Impacts Work Performance: Legal matters are not just private burdens—they affect job performance. According to ARAG, 37% of consumers reported that dealing with legal issues negatively impacted their productivity at work. These personal legal challenges often create stress and anxiety, potentially leading to burnout. By providing access to legal resources, employers can help reduce this stress and improve both mental health and job performance.

3. Adoption Requires Awareness and Accessibility: Although online legal platforms are making services more affordable and flexible than ever, legal wellness remains underused. This is largely due to a persistent lack of awareness and the outdated belief that legal support is inherently costly and complex. As more HR leaders advocate for legal education and accessible benefits, legal wellness is poised to become a standard part of holistic employee support, helping employees feel more secure and empowered in both their personal and professional lives.

New Study Finds Employers Are Prioritizing Well-Being Options for Employees. Here’s Why It Matters for Both Parties

By Allie Tribe - According to a new study, basic employee benefit packages aren’t cutting it anymore. Instead, employers are prioritizing employees’ physical, mental and financial health through more holistic well-being options. The study, Gallagher’s 2025 U.S. Benefits Benchmarks report, highlights the change in employer-provided benefits. Read Full Article…

HVBA Article Summary

1. Voluntary and Specialized Benefits Are Expanding: Nearly one-third of employers plan to expand their voluntary benefit offerings by 2027, reflecting a broader shift toward more tailored support for employees. This includes specialized health care benefits such as hearing aids, autism treatments, and bariatric surgery, as well as expanded access to reproductive health services like fertility treatments, medications, and cryopreservation.

2. New Leave Options Reflect Employee Well-being Priorities: Employers are moving beyond standard paid time off to offer more meaningful leave options that support emotional and mental well-being. These include bereavement leave for pregnancy loss, well-being or culture days, and emerging considerations like menopause-related leave, which is expected to grow as companies prioritize holistic employee care.

3. Better Benefits Drive Retention and Recruitment: With 70% of employees open to changing jobs for improved benefits, employers are increasingly leveraging comprehensive benefit packages to attract and retain top talent. In addition to health-related perks, offerings like identity theft protection and mental health resources address employees' financial and emotional concerns, helping to foster trust and long-term loyalty.

Behind the benefits game-changer for this 24K-employee school district

By Jen Colletta - Rising healthcare costs are plaguing HR and benefits professionals across industries. Mercer last year projected benefits costs would soar 5.8% in 2025—the third consecutive year of record increases and nearly double the standard increase of just a few years ago. Read Full Article…

HVBA Article Summary

1. Advanced Primary Care as a Cost-Effective Strategy: In response to escalating healthcare expenses and limited budget flexibility for salary increases, Orange County Public Schools (OCPS) implemented an advanced primary care model to control costs while remaining competitive in employee benefits. This model replaces the traditional fee-for-service approach with a fixed per-member fee, which industry experts say can significantly reduce employer spending. According to PeopleOne Health, employers utilizing this approach—like OCPS—are realizing healthcare cost savings of up to 30%.

2. Improved Access and Engagement: The employer-funded model gives OCPS employees and their dependents zero-cost access to a wide range of services, including primary care, pediatric care, mental health support, chronic condition management, and diagnostics. As of now, more than 17% of the workforce has enrolled, many of whom previously lacked a regular primary care provider. The enhanced access has led to quicker, more consistent care, with early signs pointing to reduced absenteeism, stronger employee engagement, and improved morale across the district.

3. Broader Implications in a Tight Economy: In an economic climate where even modest healthcare co-pays can deter employees from seeking care, OCPS’s no-cost model has been particularly impactful for a diverse workforce that includes teachers, bus drivers, and custodians. With Florida facing a projected shortage of over 22,000 physicians in the next five years, timely, barrier-free access to care has become critical. OCPS's large-scale communication campaign and union support helped drive awareness, with feedback from enrolled educators indicating a stronger sense of support and connection to their healthcare teams.