Congressional Report and Aetna Settlement Renew Questions About Billions in Taxpayer Spending

By Wendell Potter – Some good news on the Medicare Advantage front today for a change: The federal government will waste only $76 billion of our tax dollars this year. That’s down from $84 billion last year. Now the bad news: That $76 billion works out to about 14% more than what the government’s spending would be in traditional Medicare for the same beneficiaries, according to a new report from the Medicare Payment Advisory Commission (MedPAC), an independent congressional agency that advises Congress on issues affecting the Medicare program. Read Full Article...

HVBA Article Summary

1. Medicare Advantage Payments and Risk Coding Practices: Federal analysts have long examined whether payments to Medicare Advantage (MA) plans exceed what traditional Medicare would spend for the same beneficiaries. The Medicare Payment Advisory Commission (MedPAC) estimates that these differences amount to tens of billions of dollars annually, with some researchers suggesting the figure could reach up to $140 billion per year. Recent reductions in estimated overpayments are partly linked to the phase-in of a new federal risk-adjustment model (V28), introduced during the Biden administration to address higher payments associated with coding intensity, sometimes referred to as “up-coding.”

2. Congressional Findings on Costs and Premium Impacts: A report from the Senate Joint Economic Committee found that payment differences in the Medicare Advantage program may contribute to higher Medicare costs overall, including increases in premiums paid by seniors. According to the report, the standard Medicare Part B premium rose from $185 in 2025 to $203 in 2026, with the analysis attributing part of that increase to higher program spending. The program itself has expanded significantly, now covering about 51% of all Medicare beneficiaries, with federal payments to private insurers exceeding $530 billion annually.

3. Enforcement Actions and Market Concentration Draw Oversight: Increased scrutiny of the program has also included federal enforcement actions and policy proposals in Congress. The U.S. Department of Justice announced that Aetna agreed to pay $117.7 million to settle allegations that inaccurate diagnosis codes were submitted between 2018 and 2023 to increase Medicare payments, though the company denied wrongdoing and settled without admitting liability. The Medicare Advantage market is also concentrated among a few large insurers—UnitedHealth Group, Humana, and CVS Health’s Aetna—with government programs accounting for a major share of revenues, including roughly 77% of UnitedHealthcare’s revenue and $402.1 billion in total revenue for CVS Health/Aetna in 2025.

Midterm elections could decide the fate of HSAs

By Allison Bell – The upcoming midterm congressional elections could determine whether health savings accounts and high-deductible health plans face tough new fights in Washington. Jeanne Lambrew, a longtime Democratic health policy veteran, has hinted at the battles that might lie ahead by publishing a new opinion article calling for Congress to abandon efforts to encourage employers, insurers and consumers to use HDHPs, or to combine HDHPs with HSAs or flexible spending accounts. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Potential Policy Shifts Hinged on Elections: The outcome of the upcoming midterm congressional elections could significantly influence the future of health savings accounts (HSAs) and high-deductible health plans (HDHPs) in the United States. Depending on which party gains control, there may be increased efforts either to expand or to restrict these health care options. This highlights the political nature of health care reform and the importance of legislative control in shaping national policy.

2. Criticism of HDHPs and HSAs from Health Policy Experts: Jeanne Lambrew, a prominent health policy expert, argues that HDHPs and associated spending accounts do not effectively address the issues of high health care costs and system complexity. She points to evidence suggesting that these plans may discourage necessary care and disproportionately benefit wealthier individuals. Lambrew advocates for value-based cost sharing and greater government involvement as more effective solutions for controlling costs and improving care access.

3. Bipartisan Legislative Activity and Recent Changes: Both Republicans and some Democrats have supported HDHPs and HSAs in the past, but there has been growing scrutiny and debate over their effectiveness. Recent legislative efforts, such as the One Big Beautiful Bill Act, have aimed to expand HSA access to no-deductible primary care, reflecting ongoing attempts to modify the system. However, critics remain concerned that these changes may not resolve underlying issues of affordability and accessibility for all consumers.

Stryker investigating cyberattack that caused widespread outage

By Ricky Zipp and David Jones – Stryker is investigating a cyberattack that led to a global network disruption of its Microsoft environment. In a statement posted on LinkedIn Wednesday, Stryker said it did not believe the attack involved ransomware or other malware and added that it believed the incident was contained. “Our teams are working rapidly to understand the impact of the attack,” the company said. “Stryker has business continuity measures in place to continue to support our customers and partners. We are committed to transparency and will keep stakeholders informed as we know more.” Read Full Article...

HVBA Article Summary

1. Cyberattack Disrupts Stryker Systems and Triggers Investigation: Stryker identified a cyberattack on Wednesday and activated its cybersecurity response plan while beginning an investigation with external cybersecurity experts. The attack caused disruptions to the company’s systems, including its electronic ordering platform, and the full operational and financial impact remains unknown. The company has not yet determined whether the incident will have a material impact or provided a timeline for complete system restoration.

2. Medical Devices Remain Safe While Order Systems Are Restored: Stryker reported that its medical products, including the Mako surgical robot, Vocera communication devices, and LifePak35 monitor/defibrillator, remain safe to use. The company said it still has visibility into orders placed before the incident and plans to ship them once system communications are restored. Orders placed after the event are being reviewed while Stryker works to restore its electronic ordering system.

3. Possible Link to Iran-Associated Cyber Group Raises Security Concerns: An Iran-linked threat actor known as Handala has claimed responsibility for the attack, according to cybersecurity researchers. Analysts believe the group may be connected to Iran’s Ministry of Intelligence and Security and that targeting a major U.S. medical device company could represent a significant escalation. Experts warn that attacks on healthcare infrastructure can pose serious risks because disruptions may affect operations and potentially impact patient safety.

Less Weight Regain, More Health Loss after Stopping GLP-1s?

By Sriparna Roy – Patients on GLP-1s who stopped taking the drugs maintained about 25% of their weight loss at 1 year, but whether their regained weight is mainly fat or lean mass isn’t clear, new research suggested. “When we began this work, there was — and still is — a prevailing narrative around GLP-1 receptor agonists (RAs) that says they must be taken indefinitely or ‘you’ll gain it all back, when treatment stops,’” said Brajan Budini and Steven Luo, both medical students at the University of Cambridge, Cambridge, England. “We wanted to assess whether the evidence actually supports that view,” they told Medscape Medical News. Read Full Article...

HVBA Article Summary

1. GLP-1 Discontinuation Linked to Predictable Weight Regain: A systematic review and meta-regression of 48 studies—including 36 randomized controlled trials and 12 non-randomized studies—evaluated weight outcomes after adults with overweight or obesity stopped GLP-1 receptor agonists. Treatment durations ranged from 10 to 104 weeks, with follow-up periods of 4 to 104 weeks, and most studies were assessed as having moderate risk of bias. Across the studies, weight consistently rebounded after medication cessation, indicating that weight regain is a common outcome when treatment is discontinued.

2. Majority of Weight Loss Regained Within One Year: Researchers analyzed six randomized controlled trials involving 3,236 participants (mean age about 48 years, approximately 68% women) with data up to 52 weeks after discontinuation. The analysis found that about 60% of the weight lost during treatment was regained within one year of stopping GLP-1 therapy. Modeling suggested that weight regain slows over time and eventually plateaus at roughly 75.3% of the original weight lost, leaving about 25% of the treatment-related weight loss intact.

3. Uncertainty Remains About Health Impact of Regained Weight: Secondary outcomes such as A1c levels and systolic blood pressure generally showed rebound trends after discontinuation, although available data were insufficient for detailed modeling. Researchers noted that it remains unclear whether regained weight consists primarily of fat or lean mass, which could affect long-term metabolic health. Experts commenting on the findings also emphasized that cardiometabolic improvements may reverse after stopping weight-loss medications and suggested combining pharmacologic treatment with lifestyle interventions to support more durable outcomes.

Industry Voices—Fast answers, fragile data: the trust problem in AI-driven healthcare analytics

By Tanaya Amar – A few weeks ago, I was helping build a data view at a healthcare organization that would eventually power operational reporting. The team needed a specific metric that I hadn’t worked with before, and no one could immediately point to its source. I turned to the platform’s AI assistant and asked where it might live. It surfaced a table and column name that appeared plausible. I queried the table and the name suggested it could be the right metric. But three problems became clear almost immediately. Read Full Article...

HVBA Article Summary

1. AI Accelerates Data Discovery but Not Data Trust: AI tools embedded in modern data platforms can rapidly locate tables, columns, and potential metric definitions across large datasets. This dramatically reduces the time analysts spend searching for information and enables more self-service across teams. However, when the underlying data lacks documentation, ownership details, or contextual explanations, users cannot confirm whether the surfaced information is accurate. As a result, faster discovery improves efficiency but does not necessarily make the insights more reliable.

2. Weak Documentation Can Spread Inconsistent Metrics: In many healthcare analytics environments, legacy tables remain active even after their original logic becomes outdated. Metrics with similar names may be calculated differently by separate teams, especially when definitions and formulas are not clearly documented. When AI tools surface these fields, users may assume the information is trustworthy because it appears quickly and confidently summarized. This can allow incorrect or inconsistent metrics to spread across dashboards and reports, ultimately influencing operational decisions with flawed data.

3. Stronger Governance Is Needed for Reliable AI-Supported Analytics: To ensure trustworthy analytics in the AI era, organizations need clearer standards around how metrics are defined and maintained. Treating metric definitions as structured products—with documented calculations, intended use cases, and limitations—helps reduce ambiguity across teams. Separating exploratory analysis from official operational reporting also ensures that experimental data does not unintentionally enter decision-making dashboards. In addition, visible metric ownership, verification timelines, and documentation help both users and AI systems identify which metrics are authoritative and safe to use.

Most US workers hide caregiving duties from HR

By Jimmy Nesbitt – Many U.S. workers are juggling caregiving duties, but few feel comfortable discussing it with their HR managers, according to a new survey. Data from Sparrow shows that there's a stigma around caregiving in the workplace, especially when it comes to taking time off, says Deborah Hanus, CEO of the end-to-end leave management platform. Just 8% of employees feel comfortable talking to HR about their caregiving responsibilities, and the other 92% go to their co-workers or nowhere at all, the survey found. Even more alarming, 20% are actively hiding their caregiving responsibilities from HR, and 41% worry they will be viewed as unreliable or distracted if they come forward. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Caregiving Responsibilities Are Often Hidden in the Workplace: Survey findings show that 20% of employees actively hide their caregiving responsibilities from HR, and 41% worry they will be perceived as unreliable or distracted if they disclose them. This hesitation can lead to reduced career ambitions and limited workplace support for employees balancing work and caregiving. Experts note that when organizations offer supportive benefits and leadership awareness, employees may feel more comfortable discussing caregiving needs.

2. Caregivers Represent a Large and Growing Workforce Segment: An estimated 63 million Americans serve as caregivers, representing a 45% increase over the past decade, according to a 2025 report by AARP and the National Alliance for Caregiving. Approximately 70% of these caregivers are employed, and about 29% belong to the “sandwich generation,” caring for both children and older adults. As the oldest baby boomers approach age 80, caregiving demands are expected to increase significantly in the coming years.

3. Leadership Training and Workplace Support Are Key Strategies: Experts say workplace culture, particularly leadership behavior, plays a major role in reducing stigma around caregiving. Managers may unintentionally contribute to the issue because they lack experience or guidance on how to respond to caregiving situations. Training benefit leaders to manage intermittent leave, respond empathetically to requests, and support employees returning from leave can help organizations retain valuable workers while addressing caregiving needs.

Nearly half of all health spending in U.S. comes from 5% of population

By Michael Popke – A new KFF analysis found that 5% of the U.S. population accounted for nearly half of all health spending in 2023 — spending an average of $72,918 annually. People with health spending in the top 1% spent an average of $150,467 per year. "In a given year, a small portion of the population is responsible for a very large percentage of total health spending," according to the report, which evaluates how health expenditures vary across the population. "We tend to focus on averages when discussing health spending, but individuals' health status — and thus their need to access and utilize health care — varies over the course of their lifetimes. In fact, very few people have spending around the average." Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Disproportionate Health Spending: The KFF analysis highlights that a small segment of the U.S. population is responsible for a significant share of total health expenditures. This concentration suggests that health care costs are not evenly distributed, with a minority incurring much higher expenses due to factors such as chronic or severe health conditions. Understanding this disparity is crucial for policymakers and insurers aiming to manage costs and allocate resources effectively.

2. Demographic and Socioeconomic Variations: The report finds notable differences in health spending based on age, gender, race, and immigration status. Older adults, particularly those over 55, account for a majority of health spending despite representing a smaller portion of the population, while women in their reproductive years spend more than men. Additionally, white individuals and those born in the U.S. tend to have higher health expenditures compared to other racial groups and immigrants, reflecting broader socioeconomic and access disparities.

3. Implications for Health Policy and Insurance: The findings underscore the importance of targeted interventions for high-cost populations and the need for nuanced policy approaches. Since a large portion of the population has minimal or no health expenditures, efforts to control costs may benefit from focusing on those with the greatest needs. The data also suggest that insurance design and public health strategies should consider demographic and health status differences to improve equity and efficiency in health care spending.