UnitedHealth reports strong earnings, despite Change cyberattack

By Allison Bell - Solid performance at employer-sponsored health plans is helping UnitedHealth Group overcome the effects of a big ransomware attack on the company's Change Healthcare health data exchange unit. Read Full Article…

HVBA Article Summary

1. Strong Commercial Health Plan Performance: John Rex, UnitedHealth's president, highlighted the company's robust growth across various business segments, particularly in the commercial health plan sector. Demand from large employers and union plans has been notably strong, contributing to the positive earnings despite challenges such as the Change attack.

2. Optum Rx's Positive Impact: UnitedHealth executives expressed satisfaction with the performance of their pharmacy benefit manager (PBM), Optum Rx. Prescription volume for Optum Rx increased by 4.7% to 399 million, and its revenue was 13% higher compared to the same quarter last year. The company attributed this success to strategic investments in the pharmacy and PBM business.

3. Financial Performance and Challenges: UnitedHealth reported $4.4 billion in net income on $99 billion in revenue for the second quarter, showing growth despite the financial impact of the Change ransomware attack, which cost the company $2 billion. This attack had disrupted services for weeks, but most functionalities have now been restored, with enhanced security and capability. The company's commercial domestic revenue saw an 11% increase, and commercial health plan enrollment rose by 8.8% to 29.6 million.

Private Medicare Plans and Vertical Integration Yields UnitedHealth $15.8 Billion in Profits Between January and June

By Wendell Potter - UnitedHealth Group, the largest health insurance conglomerate by far, continues to show how rewarding it is for shareholders when corporate lawyers find loopholes in well-intentioned legislation – and game the Medicare Advantage program in ways most lawmakers and regulators didn’t anticipate and certainly didn’t intend – to boost profits. Read Full Article…

HVBA Article Summary

1. Operating Profits Surge: UnitedHealth reported a substantial increase in operating profits, reaching $15.8 billion in the first half of this year, compared to $4.6 billion during the same period in 2014. This remarkable growth is largely attributed to the company's aggressive "vertical integration" strategy, which includes acquiring hundreds of healthcare delivery entities over the past decade, enabling it to direct millions of enrollees to its own doctors, clinics, and pharmacies.

2. Medicare Advantage Scheme: A significant portion of UnitedHealth's profitability stems from manipulating the Medicare Advantage program. According to a recent Wall Street Journal investigation, the company has exaggerated the severity of illnesses among its enrollees to receive higher payments from the federal government. This scheme generated $8.7 billion in 2021 alone, contributing to UnitedHealth's net income of approximately $17 billion that year. The report claims that Medicare Advantage insurers collectively defrauded the government of over $50 billion between 2018 and 2021, with UnitedHealth taking the largest share.

3. Revenue Shift to Public Programs: UnitedHealth has seen a dramatic shift in its revenue sources over the past decade, with substantial growth in public programs like Medicare Advantage and Medicaid. By the end of the second quarter of 2023, revenue from Medicare and Medicaid totaled $51.1 billion, compared to $16.8 billion from commercial plans. This shift highlights the profitability of taxpayer-supported programs, with Medicare Advantage showing the highest gross margins among insurers. The company's other major division, Optum, has also shown impressive growth, contributing $62.9 billion to total revenues in the second quarter of 2024, up from $11.7 billion in the same period in 2014.

Benefits balancing act: Employers struggle to offer affordable, attractive packages

By Alan Goforth - Providing an attractive benefits package at an affordable price remains a challenge for employers. "Trends in the employee benefits market tend to reflect what's happening socially and economically, and this year is no exception," said Sally Prather, executive vice president and national employee benefits practice leader for Alera Group. Read Full Article…

HVBA Article Summary

1. Rising Medical Plan Rates and Steady Dental Rates: The Alera Group's 2024 Employee Benefits Benchmarking Report highlights that nearly 80% of medical plans surveyed experienced an average rate increase of 9%. Despite these rising medical plan costs, dental rates have remained steady, with minimal increases compared to the previous year.

2. Increase in Pharmacy Tiers and High-Cost Specialty Medications: The report reveals a trend towards more pharmacy tiers, with an increasing number of employers offering five tiers to manage the escalating pharmacy rate increases and the high costs associated with specialty medications. This shift underscores the growing complexity employers face in addressing the demand for expensive specialty drugs.

3. Expansion of Supplemental Benefits and Rise in Self-Funding: Employers are responding to employee demand for additional coverage by offering more supplemental benefits such as critical illness coverage, disability income, and accident insurance. Additionally, there is a notable rise in the number of employers with over 100 employees transitioning to self-funding their health insurance plans, driven by the need to manage rising health insurance premiums.

5 strategies for rolling out a menopause benefits program

By Joanna Strober - It's clear that menopause benefits are becoming more mainstream, and HR and benefit professionals are taking notice. Most women are demanding support in the workplace for this life stage, and more organizations are listening. Mercer estimates that the number of large organizations offering or planning to offer specialized menopause benefits more than tripled to 15% this year from 4% in 2023. Read Full Article…

HVBA Article Summary

1. Impact of Menopause on Careers and Health: Menopause symptoms, such as brain fog, fatigue, mood changes, and hot flashes, can severely affect women's careers, with 50% of women being less likely to apply for promotions and 23% considering leaving their jobs due to these symptoms. Beyond the workplace, untreated menopause symptoms interfere with daily activities, affect relationships, and increase the risk of long-term health issues, including heart disease, diabetes, weight gain, osteoporosis, and dementia.

2. Employer Benefits of Supporting Menopause: Employers have a unique opportunity to help women in midlife thrive, which also supports their organizational goals. Providing menopause benefits can attract and retain talent, reduce absenteeism and presenteeism, and enhance productivity and morale. These benefits demonstrate a commitment to employee well-being and inclusion, positioning menopause support as a strategic imperative for organizations.

3. Effective Implementation Strategies: Rolling out menopause benefits is just the beginning; strategies to drive engagement and ensure successful outcomes are crucial. These include partnering with providers that focus on medical care, prioritizing culturally sensitive care, leading with education, engaging company allies, and reaching the full population. By following these strategies, employers can create a supportive workplace environment, increase awareness, and ensure the menopause benefits program is effective and valuable for both the organization and its employees.

As GLP-1 sales surge, insulin users fear Novo Nordisk and Eli Lilly will move on without them

By Elaine Chen - Around the world, patients suddenly can’t find enough of the insulins made by companies they have long relied on to do so. In the U.S., Novo Nordisk’s recent decision to discontinue a product has left patients with fewer options. At the same time, patients are encountering shortages of other products from Novo and Eli Lilly. Read Full Article…

HVBA Article Summary

1. Global Shortages and Impact on Patients: Patients worldwide, from the U.S. to the U.K. and South Africa, are experiencing critical shortages of insulin vials and pens, causing significant disruptions in their diabetes management. The reasons for these shortages are multifaceted, including increased demand and supply chain issues, but there is growing concern that insulin manufacturers may be diverting resources to more profitable GLP-1-based drugs for diabetes and obesity.

2. Shift in Manufacturer Focus: Major insulin manufacturers like Novo and Lilly are reportedly focusing more on GLP-1 drugs, which are seeing soaring demand and are highly profitable, as opposed to insulin products. Analysts and patient advocates worry this shift could lead to decreased production and availability of insulin, leaving patients, particularly those with type 1 diabetes, vulnerable and struggling to manage their condition.

3. Financial and Ethical Implications: The insulin market has been under pressure from policymakers to lower prices, diminishing its profitability. In contrast, GLP-1 drugs are expected to generate massive revenues, driving companies to prioritize their production. While pharmaceutical companies have a fiduciary duty to their shareholders, patient advocates argue they also bear a moral responsibility to ensure continuous and affordable access to essential medications like insulin.

Pa. legislators pass bill designed to help community pharmacies stay in business, regulate 'middlemen'

By Russ O’Reilly - Westmont Rexall Drug Store and nine Mainline Pharmacy locations have shuttered within the past four months, even as support from patients in the Johnstown area remained strong. Read Full Article…

HVBA Article Summary

1. Financial Challenges Faced by Community Pharmacies: Community pharmacies, such as Martella’s Pharmacy in Johnstown, are struggling to stay afloat due to low reimbursements paid by pharmacy benefit managers (PBMs). These reimbursements often do not cover the wholesale costs of medications, leading to financial strain and closures of many local pharmacies.

2. Legislative Action for PBM Regulation: The Pennsylvania legislature passed a significant bill proposed by state Rep. Jessica Benham aimed at regulating PBMs. The bill, which awaits the governor’s signature, aims to ensure fair reimbursement practices, prohibit clawbacks and patient steering, and mandate transparency in PBM operations. This legislation is seen as a crucial step to support local pharmacies and reduce costs for patients.

3. Ongoing FTC Investigation: The Federal Trade Commission (FTC) has been investigating PBM practices, revealing that the “big three” PBMs—CVS Caremark, Express Scripts, and Optum Rx—reimburse their affiliated pharmacies significantly more than unaffiliated ones. This finding supports claims from community pharmacists that PBMs engage in practices detrimental to independent pharmacies. The FTC’s interim report suggests that further scrutiny at both state and federal levels is necessary to address these disparities.

Health-Care Companies Are Sending Your Data to Big Tech

By Jessica Nix - California-based health system Kaiser Permanente recently alerted millions of people that their private information was inappropriately shared with tech giants, angering patients who weren’t aware of the practice. Read Full Article…

HVBA Article Summary

1. Prevalence and Impact of Trackers on Health Websites: A Bloomberg News analysis found that major healthcare companies use online trackers on their websites, often without patients' knowledge. Trackers from companies like Meta, Adobe, and Quantum Metric were found to access sensitive personal information such as dates of birth, Social Security numbers, and phone numbers on registration and login pages. These trackers pose significant privacy risks, potentially exposing intimate details of patients' lives to advertisers and data brokers.

2. Federal Regulatory Actions and Legal Challenges: Federal regulators, including the Federal Trade Commission and the Health and Human Services Department, have attempted to address the issue of personal data harvesting on health websites. Several telehealth companies have been fined, and guidance has been issued stating that online trackers could violate federal health privacy rules. However, regulatory efforts face legal challenges, as evidenced by a recent Texas court ruling limiting the HHS's authority to penalize healthcare companies for using trackers.

3. Lawsuits and Industry Responses: Legal actions are increasing against healthcare companies for using trackers that collect personal data. Notable cases include lawsuits against Kaiser Permanente and the Blue Cross Blue Shield Association, alleging that trackers transmitted sensitive information to tech companies. In response to growing scrutiny and legal pressures, some healthcare companies have removed trackers from their websites. However, concerns remain about the transparency and ultimate destinations of the data collected by these trackers.

Tau-Focused Asceneuron Adds $100M as Oral Alzheimer’s Drug Advances to Phase 2 Trial

By Frank Vinluan - Alzheimer’s disease patients can now choose between new two intravenously infused therapies that work by breaking up plaques of amyloid protein in the brain. Asceneuron takes a different approach with oral therapies that address the buildup of tau, a protein that’s also associated with the neurodegenerative disorder. The biotech now has $100 million to advance its lead program to Phase 2 testing. Read Full Article…

HVBA Article Summary

1. Asceneuron Secures Series C Financing Led by Novo Holdings: Asceneuron has announced a successful Series C financing round led by Novo Holdings, which manages the assets of the Novo Nordisk Foundation, the controlling shareholder of Novo Nordisk. This financing round also included new investors EQT Life Sciences – LSP Dementia Fund, OrbiMed, and SR One, alongside existing investors such as M Ventures and Johnson & Johnson Innovation—JJDC.

2. Advancements in Alzheimer’s Drug Development: Asceneuron's lead drug candidate, ASN51, aims to block the enzyme OGA, which is involved in protein aggregation. This approach is intended to slow the progression of Alzheimer’s disease by preventing tau aggregation. Phase 1 tests have shown promising results, and the company plans to begin Phase 2 clinical trials to further assess the drug's effectiveness in Alzheimer's patients. The startup also developed ASN90, another OGA inhibitor targeting progressive supranuclear palsy (PSP), which has been licensed to Ferrer for further development.

3. Broadening Focus on Neurodegenerative Diseases: In addition to advancing ASN51, Asceneuron aims to use its newly acquired funds to push forward its pre-clinical programs targeting other neurodegenerative diseases such as Parkinson's and amyotrophic lateral sclerosis (ALS). The company’s CEO, Barbara Angehrn Pavik, emphasized that this investment round validates their OGA inhibitor pipeline's potential and leadership in tauopathy research, highlighting their commitment to expanding treatment options for patients suffering from these conditions.

Seven Starling Secures $10.9M To Improve Access to Women’s Mental Health

By Marissa Plescia - Seven Starling, a virtual women’s behavioral health company, announced Tuesday that it raised $10.9 million in Series A funding, which it will use to help more women access its services. Read Full Article…

HVBA Article Summary

1. Focus and Services: Seven Starling, a Washington, D.C.-based company, initially targets maternal mental health, with plans for broader life phase expansions. Referred by their OBGYN, women are paired with perinatal mental health specialists and receive group therapy, medication management, patient advocacy, and in-app content. The company is in network with major insurers like UnitedHealthcare, Aetna, and Cigna.

2. Funding and Female Leadership: Seven Starling secured $14.3 million in Series A funding led by RH Capital, with significant female investor participation and an all-female board. This milestone is notable in the male-dominated venture capital space, highlighting a shift towards female-driven investments in women's health. The funding will enable Seven Starling to expand patient access, including Medicaid acceptance and extending services to 10-15 more states.

3. Mission and Broader Impact: Co-founder and CEO Tina Beilinson Keshani emphasizes Seven Starling's mission to enhance access to women's behavioral health services and reduce stigma. The company addresses the high prevalence of untreated perinatal mental health issues, aiming to fill this gap with comprehensive support. Seven Starling is also part of a federal task force on maternal mental health, aligning with recent federal funding initiatives to improve women's behavioral health.

Why can't employers bargain for lower health care prices? A plan director explains

By Allison Bell - Health care providers and the health insurers that act as third-party administrators for self-funded health plans blame each other for high U.S. health care costs. Read Full Article…

HVBA Article Summary

1. Anti-Competitive Provisions in Provider Contracts: Cora Opsahl, the director of the 32BJ Health Fund, highlighted several anti-competitive provisions in provider contracts that obstructed their ability to negotiate better prices and quality care. These provisions included mandatory inclusion of expensive hospitals in provider networks, restrictions on tiering providers, and limits on access to claims data. Such clauses severely hindered the fund's capacity to conduct thorough reviews and recoup excess payments, thereby impacting their bargaining power.

2. Impact on Health Plan Bidding and Transparency: Opsahl testified at a Senate Aging Committee hearing on the lack of health care price transparency, stating that contract terms between carriers and providers hinder the ability of employers to act on their data. These restrictive provisions prevent a competitive bidding process for TPAs, making it challenging for self-funded plans like the 32BJ Health Fund to secure better deals. This lack of transparency and competitive bidding ultimately harms employer-sponsored plans and their members.

3. Economic Consequences for Union Members: Over the past decade, the share of total compensation spent on health care for members of the 32BJ Health Fund has increased from 17% to 37%. Opsahl emphasized that if health care spending had risen at the same rate as inflation, union members could have seen an additional $5,000 in annual wages. This significant rise in health care costs underscores the detrimental economic impact of the anti-competitive provisions in provider contracts on workers' compensation.