White House and CMS to launch Health Tech Ecosystem Initiative to expand use of digital health with a focus on consumers

By Emma Beavins - President Donald Trump spoke about the new health data sharing initiatives at the White House on Wednesday afternoon, seated next to Health Secretary Robert F. Kennedy Jr., CMS Administrator Mehmet Oz, CMS Advisor and DOGE Administrator Amy Gleason and AI and Crypto Czar David Sachs. Read Full Article…

HVBA Article Summary

1. Broad Industry Commitment to Health Data Standards: The Trump administration, alongside CMS and HHS, announced voluntary commitments from 60 major healthcare and technology companies—including Amazon, Apple, Google, and OpenAI—to standardize electronic medical record systems. The aim is to ensure interoperability across different platforms by 2026, enabling seamless data sharing between providers and enhancing patient access to their own health records.

2. CMS Interoperability Framework and Aligned Networks: A new voluntary CMS Interoperability Framework outlines goals such as patient data access via APIs, secure identity verification, and federated network integration. By July 4, 2026, participating networks must comply with data-sharing standards like FHIR and provide real-time notifications and claims access. 21 networks have already pledged to become CMS Aligned Networks.

3. Patient-Centric Digital Health Shift: The initiative emphasizes consumer-focused care by promoting tools like AI-driven assistants, digital check-in systems, and apps for managing chronic conditions such as diabetes and obesity. This includes eliminating repetitive paperwork, enabling remote monitoring, and creating a more user-friendly healthcare experience, with privacy and opt-in participation as key tenets.

CVS, Cigna and UnitedHealth win court battle over Arkansas pharmacy ban

By Allison Bell - A federal judge in Arkansas has issued a preliminary injunction blocking implementation of a new Arkansas law that prohibits pharmacy benefit managers from owning pharmacies in the state. Arkansas pharmacies and many Arkansas state legislators say implementing the PBM ownership ban would keep big PBMs from using their huge size and their own pharmacies to eliminate competition from local pharmacies. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Court Blocks Arkansas PBM Law on Constitutional Grounds: A federal judge issued a preliminary injunction against an Arkansas law aimed at regulating pharmacy benefit managers (PBMs), finding that it likely violates the U.S. Constitution’s interstate commerce clause. The judge concluded that the law discriminates against out-of-state PBMs and imposes an excessive regulatory burden, especially given that Arkansas already has other laws in place to protect local pharmacies from unfair practices.

2. ERISA Preemption Argument Rejected by Judge: The court did not find merit in the plaintiffs’ claim that the Arkansas law violated the Employee Retirement Income Security Act (ERISA). The judge ruled that the law regulates pharmacy licensing rather than directly interfering with employee benefit plans. Any influence the law might have on such plans was considered indirect and therefore not enough to trigger ERISA preemption.

3. Broader Implications for State Regulation and Health Care Integration: The litigation is being closely watched across the country, as it could set a precedent for how states attempt to regulate health care companies, particularly in cases involving vertical integration. Stakeholders such as employer groups and antitrust advocates view the case as a potential model for challenging or defending state laws aimed at managing the growing consolidation within the health care and pharmaceutical supply chains.

UnitedHealth expects lower profits in 2025 amid medical cost spike

By Rebecca Pifer - UnitedHealth announced the abrupt exit of its CEO Andrew Witty in May, along with fully withdrawing its 2025 outlook. As such, the second quarter is the company’s first under Hemsley, the chairman of UnitedHealth’s board and its CEO from 2006 to 2017. Read Full Article… 

HVBA Article Summary

1. Leadership Overhaul Signals Shift at UnitedHealth: Facing federal investigations, eroded investor confidence, and a 44% stock decline in 2025, UnitedHealth Group is undergoing a leadership-led turnaround under CEO Andrew Witty’s successor, Dirk Hemsley. The company acknowledged operational and pricing missteps and announced a push for cultural reform, greater transparency, and independent oversight, with plans to release a comprehensive policy review later this year.

2. Rising Medical Costs Undermine Profitability: UnitedHealth slashed its 2025 earnings forecast as surging medical utilization—especially in Medicare Advantage, Medicaid, and ACA markets—outpaced pricing assumptions. Executives cited growing demand for outpatient and emergency care, behavioral health, and high-acuity services. The company plans to raise premiums, reduce benefits, and exit underperforming markets affecting over 600,000 MA members to regain margin control.

3. Business Units Struggle Amid Systemic Strain: Both UnitedHealthcare and Optum divisions are grappling with falling profits. OptumHealth, in particular, is seeing negative margins from high-need patients and struggles with risk model transitions and reimbursement gaps. With spending pressures mounting and funding challenges persisting, UnitedHealth aims to exit certain value-based contracts and limit exposure through 2026 to restore financial stability.

Direct Primary Care Will Become Much More Popular Thanks to New Law, Experts Predict

By Joyce Frieden - A new provision related to direct primary care (DPC) in the recently enacted reconciliation bill will create more opportunities for physicians in small towns to open independent practices, Jeff Davenport, MD, of Edmonton, Oklahoma, said Tuesday. "What an opportunity for small-town America to have a doctor be able to practice in a model like this and have more expanded opportunities," Davenport said at an event sponsored by Primary Care for America, an organization whose members include the American Academy of Family Physicians. Read Full Article…

HVBA Article Summary

1. DPC Accessibility Expands with New Law (Effective 2026): Starting January 1, 2026, a new federal provision will allow individuals with Health Savings Accounts (HSAs) paired with high-deductible health plans to participate in Direct Primary Care (DPC) arrangements. They will also be able to pay DPC fees—up to $150/month for individuals and $300/month for families—using tax-deductible HSA funds. This change is expected to significantly boost enrollment and make DPC more attractive to employers as part of comprehensive benefit offerings.

2. Potential Benefits for Patients and Employers: The DPC model provides patients with unlimited primary care access for a flat monthly fee, which typically includes office visits, telehealth, and discounted services like lab tests and imaging. For employers, this approach offers a way to deliver more responsive and preventive care, potentially improving employee health outcomes and reducing long-term healthcare costs by addressing issues earlier and more efficiently.

3. Implementation May Be Gradual Despite Growth Potential: While the new rules are expected to drive greater interest in DPC, widespread adoption among physicians may take time. Many providers are hesitant to leave traditional fee-for-service models due to concerns about patient acquisition and operational change. However, as awareness and demand grow—especially among employers and patients—this hesitation may decrease, creating new opportunities for physicians willing to transition to the DPC model.

Benefits Think: How the One Big Beautiful Bill will impact telehealth coverage for HDHPs

By Caroline Savello - With the passage of the One Big Beautiful Bill Act, Congress has made permanent the safe harbor allowing high-deductible health plans (HDHPs) to cover telehealth and other remote services before the deductible is met. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. New Policy Enables Greater Flexibility in Health Benefits: A recent policy change introduces a "safe harbor" provision that gives employers more flexibility in designing benefit plans, particularly within high-deductible health plans (HDHPs). This change allows for improved access, availability, and utilization of essential health services—especially for high-cost conditions like cancer—helping employers better support employees who face financial or geographic barriers to care.

2. Cost Barriers Lead to Delayed Care and Poorer Health Outcomes: With about 50% of private-sector employees enrolled in HDHPs, many individuals face deductibles that can consume a significant portion of their household savings. This financial pressure often leads to delayed or skipped preventive care, such as screenings and follow-ups, increasing the risk of late-stage diagnoses and costly complications, particularly among rural and underserved populations.

3. Telehealth Presents a Scalable, Cost-Effective Cancer Care Solution: The growing infrastructure for virtual care enables employers to offer key components of cancer care—like risk assessments, nutrition consults, and diagnostic follow-ups—remotely. This approach not only enhances accessibility and consistency of care across employee populations, especially in rural areas, but also reduces costs for employers and the healthcare system by eliminating travel time, facility expenses, and lost productivity.

Trump administration releases AI adoption plan

By Emily Olsen - The plan was created as a result of a January executive order issued by President Donald Trump that aims to ensure the U.S. continues to be a competitive player in AI development. A portion of the plan focuses on removing red tape for AI implementation, including asking federal agencies to consider limiting funding for states that have “burdensome” AI regulations. The plan, however, doesn’t detail which state laws could be considered onerous.. Read Full Article…

HVBA Article Summary

1. Federal Push for AI Development: The Trump administration released an action plan focused on accelerating the adoption of artificial intelligence across U.S. industries. A key element of the plan is the removal of what it describes as “onerous” regulations that could slow AI innovation. The plan also includes the creation of AI Centers of Excellence, which will support the testing and deployment of AI tools through agencies like the FDA, marking one of the administration’s first steps toward a national AI strategy.

2. Limited Healthcare Focus, but Notable Implications: While the plan does not emphasize healthcare, it proposes forming domain-specific stakeholder groups — including in healthcare — to help develop national AI standards and measure productivity improvements. Industry leaders, such as Premier and the EHR Association, have responded positively, underscoring the value of consistent federal guidance over fragmented state regulations that could hinder innovation and compliance.

3. Opportunities and Challenges in Healthcare AI: Healthcare leaders view AI as a promising solution for addressing issues like staff shortages and administrative burdens. However, they also recognize significant risks, including algorithmic bias, inaccuracy, and the complexity of implementation and oversight. These concerns underscore the need for a comprehensive, risk-based federal framework — something previous administrations, including Biden’s, had attempted to initiate but remain largely underdeveloped.

7 guiding principles for smarter employee benefits design

By Julie Turpin - Companies often confuse perks with benefits. Ping-pong tables, kombucha taps, and snack bars make for great recruiting photos. Still, they don’t replace what supports people: mental health care, parental leave, fertility support, financial planning resources, and development opportunities. Read Full Article…

HVBA Article Summary

1. Benefits as Strategic Investments Reflect Cultural Priorities: When employee benefits are treated as long-term strategic investments instead of short-term perks, they become a powerful reflection of an organization’s core values and workplace culture. This approach allows companies to align benefit offerings with what they genuinely prioritize, sending a clear message about their commitment to supporting employee well-being and inclusion.

2. Employee-Centered Design Drives Relevance and Engagement: The most effective benefits programs are built on ongoing, multidimensional employee feedback and delivered through clear, relatable communication—such as persona-based storytelling tied to real-life stages. These efforts help ensure that offerings are relevant, accessible, and meaningful, ultimately driving higher levels of participation, satisfaction, and trust across the workforce.

3. Continuous Improvement and Long-Term Planning Sustain Impact: Benefits should be managed as dynamic, evolving systems that adapt to changing employee needs and business realities. Through consistent evaluation, willingness to make midyear adjustments, and multi-year planning, organizations can ensure sustainability, address rising costs, and maintain a competitive edge while meeting future workforce expectations.