Change Healthcare sued by CareFirst BlueCross BlueShield over last year’s data breach

By Alan Goforth - The fallout from the massive February 2024 cyberattack against Change Healthcare continues more than a year later. CareFirst BlueCross BlueShield of Maryland is the latest company to sue over the data breach. The lawsuit, filed in a Maryland state court in late February, alleges that the UnitedHealth Group subsidiary’s cybersecurity standards were insufficient to prevent the attack. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Cyberattack and Lawsuit: A Russian ransomware group exploited stolen credentials to access a company portal without multifactor authentication, leading to a major cyberattack. CareFirst is now suing for $900,000 in damages, citing significant data loss and financial strain.

2. Industry-Wide Impact: The attack on Change Healthcare disrupted care delivery nationwide, exposing 190 million individuals' data and costing UnitedHealth over $3 billion. Nebraska has also sued Change Healthcare for allegedly inadequate security measures.

3. Ongoing Fallout: Change Healthcare continues to issue data breach notifications, with affected individuals still being informed months after the attack. The incident has intensified scrutiny on cybersecurity vulnerabilities in the healthcare industry.

Speaker Mike Johnson releases funding patch with 6-month telehealth extension, no doc pay fix

By Emma Beavins - Saturday, House Speaker Mike Johnson released a bill that would fund the government through Sept. 30, avoid a partial government shutdown and extend expiring healthcare programs such as Medicare telehealth, funding for community health centers and a pay adjustment for certain low-volume hospitals. Read Full Article…

HVBA Article Summary

1. Pressure to Address Medicare Physician Pay Cuts: The funding patch does not include a fix for the 2.83% Medicare physician pay cut, increasing pressure on Congress to pass a broader healthcare package. Physicians and advocacy groups warn that continued cuts threaten access to care for millions of Medicare patients, making it likely that lawmakers will pursue a legislative fix.

2. Extension of Key Medicare and Telehealth Provisions: The bill temporarily extends certain Medicare telehealth flexibilities, including the removal of geographic barriers and the continuation of tele-mental health services, audio-only telehealth, and hospice recertification via telehealth. However, some flexibilities, such as telehealth for high-deductible health plan beneficiaries, are excluded.

3. Congressional Divisions and Budget Constraints: While Senate Democrats have proposed a broader healthcare reform package that includes a Medicare physician pay increase and pharmacy benefit manager reforms, House Republicans may resist due to spending concerns. The House Energy and Commerce Committee faces an $880 billion deficit reduction target, limiting its willingness to support reforms requiring significant offsets.

HHS warns scheme to defraud Medicare, Medicaid resulted in millions lost

By Jackson Walker - The Department of Health and Human Services (HHS) on Monday issued a warning that fraudsters are targeting federal health programs with a scheme that led to millions of dollars in losses. The scheme, according to the HHS Office of Inspector General (OIG), targets Medicare and Medicaid with fraudulent funds transfer requests from individuals posing as healthcare providers. Read Full Article…  

HVBA Article Summary

1. Rising Threat of Electronic Funds Transfer Fraud: A significant portion of health contractors and agencies have suffered financial losses due to fraudulent payments linked to unauthorized access and electronic funds transfer (EFT) fraud. In 2023 alone, cybercriminals exploited vulnerabilities in the HHS grant Payment Management System, resulting in multimillion-dollar losses.

2. Security Gaps and Internal Threats: A majority of surveyed health organizations acknowledged being targets of fraud schemes, with common attack methods including phishing, email impersonation, and insider threats. The Office of Inspector General (OIG) has urged stronger collaboration with Medicare contractors and enhanced security measures to combat evolving cyber threats.

3. Broader Concerns About Federal Spending and Fraud: The revelations about health care fraud come amid growing scrutiny over government spending. Critics, including the Cato Institute, warn that federal subsidies foster dependency and distort economic growth, advocating for cuts to “corporate welfare” programs to promote market freedom and reduce the federal deficit.

HDHP decline: Implications of falling enrollment for benefits advisors

By Divya Sangameshwar - For the better part of the last decade, high-deductible health plans (HDHPs) have been a growing segment in the employee health care space. The percentage of private sector employees enrolled in HDHPs increased every year from 2013 to 2021, exceeding 50% for the first time in 2019. But that’s no longer the case. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Increased Employee Scrutiny on Health Care Plans: As HDHP enrollment declines, employees are demanding more education and transparency about their health care options. Advisors must be prepared to address concerns about costs, unexpected medical expenses, and plan suitability, especially as younger generations, like Gen Z, seek more clarity.

2. The Rise of Alternative and Lesser-Known Health Plans: With POS plans growing in popularity, advisors should also stay informed about emerging alternatives such as reference-based pricing (RBP) and prepaid health care cards. These unconventional plans are expected to gain traction as HDHPs lose dominance.

3. When HDHPs Still Make Sense: Despite the overall decline, HDHPs remain beneficial for certain employees, particularly those who are healthy, want to maximize their Health Savings Accounts (HSAs), or can afford to pay medical costs upfront. Advisors should also consider regional trends, as HDHP enrollment is increasing in specific states.

Millions in US Live in Places Where Doctors Don’t Practice and Telehealth Doesn’t Reach

By Sarah Jane Tribble and Holly K. Hacker - Green lights flickered on the wireless router in Barbara Williams’ kitchen. Just one bar lit up — a weak signal connecting her to the world beyond her home in the Alabama Black Belt. Next to the router sat medications, vitamin D pills, and Williams’ blood glucose monitor kit. Read Full Article…

HVBA Article Summary

1. The Digital and Healthcare Divide in Rural America: Millions of Americans, particularly in the rural South, Appalachia, and remote Western regions, face a dual challenge: a lack of reliable high-speed internet and a shortage of healthcare providers. This combination exacerbates chronic illnesses like diabetes, limiting access to telehealth services that could improve health outcomes.

2. Barriers to Broadband Expansion and Policy Challenges: Despite significant federal investments, such as the $42 billion "Internet for All" initiative, broadband expansion efforts are hindered by political debates, regulatory delays, and high infrastructure costs. Competing interests and policy shifts have made it difficult to bridge the digital divide effectively.

3. The Impact of Connectivity on Health and Quality of Life: Access to high-speed internet is increasingly tied to healthcare accessibility, economic opportunity, and overall well-being. In areas with poor broadband, residents like Williams struggle to manage chronic conditions effectively, while those in well-connected regions benefit from telehealth, digital monitoring, and better healthcare access.

Recent Decade Saw No Change in Diabetes Prevalence in U.S. Adults

By Elana Gotkine and Mark Arredondo, M.D. - Between 2013 and 2023, there was no change in the prevalence of diabetes among U.S. adults, but glycemic control worsened, according to a research letter published online Feb. 27 in the Journal of the American Medical Association. Read Full Article…

HVBA Article Summary

1. Stable Prevalence, Worsening Control: The prevalence of diabetes among U.S. adults remained relatively stable between 2013 and 2023, rising slightly from 12.8% to 14.1%. However, glycemic control worsened, with mean HbA1c levels increasing from 7.31% to 7.60% and glycemic control rates dropping from 54.3% to 43.5% between 2017-2020 and 2021-2023.

2. Young Adults at Higher Risk: The most significant deterioration in glycemic control was observed among young adults aged 20 to 44 years, with their mean HbA1c levels rising from 7.43% to 8.51% and their glycemic control rates plummeting from 57.4% to 37.1%. Other demographic subgroups did not show similar trends.

3. Public Health and Policy Implications: The study highlights concerns about worsening diabetes control, particularly in younger populations, which could lead to higher risks of cardiovascular complications and stagnating mortality improvements. The authors emphasize the need for targeted public health interventions and policy measures to address this issue.

Vertex’s new pain drug gets first coverage nod from major insurer

By Jacob Bell - Optum Rx, a pharmacy benefit manager owned by one of the country’s largest insurance companies, UnitedHealth Group, has added a new, much-anticipated pain drug to some of its commercial formularies. Sold as Journavx, the drug received U.S. approval in late January as a treatment for the short-lived “acute” pain typically felt after an operation or accident. Read Full Article…

HVBA Article Summary

1. Journavx as a Non-Opioid Pain Management Option: Developed by Vertex Pharmaceuticals, Journavx offers a novel, non-opioid alternative for pain relief, distinguishing itself from conventional opioid medications. Its high cost, however, presents challenges compared to widely available, inexpensive generic opioids.

2. Insurance Coverage and Accessibility Concerns: While some insurers, like Optum Rx, have added Journavx to their formularies, its Tier 3 placement indicates higher costs for patients. Broader adoption among major insurers, including CVS, Humana, and Cigna, remains uncertain, potentially limiting widespread access.

3. Industry and Analyst Perspectives on Market Potential: Analysts foresee significant commercial potential for Journavx, with expectations of broad insurance coverage due to growing demand for non-opioid pain treatments. Early coverage decisions by UnitedHealth and select Medicaid programs suggest optimism for wider adoption, though pricing and reimbursement remain key concerns.

Hospital at Home: A Glimpse at Acute Care in 2050

By Sarah Yahr Tucker - The sun’s not up yet, and my chest feels tight. Sitting up in bed, the room slides briefly out of focus. I attempt a deep breath… Sharp needles pierce deep into my chest. The cough I downplayed yesterday tears up my throat as I shiver with a chill. Read Full Article…  

HVBA Article Summary

1. Advancements in Home-Based Acute Care: By 2050, acute-level care at home will be a standard practice, supported by AI-driven diagnostics, wearable sensors, and enhanced telehealth systems. Patients with serious conditions like pneumonia, heart failure, and sepsis will receive hospital-grade care in their own bedrooms, reducing the need for traditional hospital stays.

2. Challenges in Implementation: Technology and Logistics: The success of the Hospital at Home (HaH) model depends on developing robust supply chain logistics and advanced software systems to coordinate medical services. Experts emphasize that delivering seamless in-home care requires real-time monitoring, efficient coordination of medical supplies, and highly skilled remote healthcare professionals.

3. Financial and Workforce Considerations: The future of HaH depends on securing long-term financial support from policymakers and healthcare providers. While the model offers cost savings, concerns remain over potential profit-driven motives, shifts in medical roles, and the ability to maintain high-quality patient care outside hospital settings.