'Shameful': AARP's Partnership with Healthcare Giant Faces Backlash Amid Recent Controversies

By Fox Business - A partnership between AARP, the top interest group in the United States dedicated to the plight of seniors, is facing growing scrutiny over its partnership with UnitedHealthcare as the healthcare giant faces a growing number of controversies. Read Full Article…  

HVBA Article Summary

1. AARP's Corporate Royalties Outpace Membership Dues: AARP now generates over a billion dollars annually from corporate royalties, more than three times its revenue from membership dues. A significant portion of these royalties comes from its partnership with UnitedHealthGroup, which involves collecting a 5% skim from AARP-branded UnitedHealth insurance premiums.

2. Criticism of AARP’s Alignment with UnitedHealth Over Seniors: Critics, including American Commitment President Phil Kerpen, argue that AARP prioritizes UnitedHealth’s interests over those of seniors. Kerpen claims that AARP supported the Inflation Reduction Act despite seniors largely opposing it, as the legislation benefited UnitedHealth through price controls and expanded Obamacare subsidies.

3. AARP and UnitedHealth’s Lucrative Partnership Since 1997: AARP's partnership with UnitedHealth, established in 1997, has proven highly profitable, with AARP lending its branding to UnitedHealth’s Medicare-related products. Forbes has described this arrangement as a "marketing coup," solidifying AARP's financial ties to the insurance giant.

RFK Jr.'s HHS picks up Biden admin legal fight against 340B rebates

By Dave Muoio - The Department of Health and Human Services (HHS) has filed for summary judgment in its favor regarding lawsuits brought by pharmaceutical companies that attempted to reinvent hospital discounts through the 340B program—the first explicit sign that the new administration is taking up its predecessor’s stance on the controversial industry issue. Read Full Article…

HVBA Article Summary

1. HHS Defends 340B Program Integrity Against Drugmakers' Rebate Model: The HHS, now naming Secretary Robert F. Kennedy Jr. as a defendant, has urged the courts to rule against pharmaceutical giants Eli Lilly, Bristol Myers Squibb, and Novartis Pharmaceuticals in a lawsuit over their proposed 340B rebate model. The department asserts that allowing the model would disrupt the program’s long-standing structure, which has provided discounted drugs to safety-net providers for over three decades.

2. Legal Battle Over Rebate Model Intensifies: Drugmakers argue that HRSA’s rejection of their rebate model violates the Administrative Procedure Act and limits flexibility in 340B program implementation. However, HHS maintains that its actions were legally justified and aligned with the program’s original intent. The lawsuit reflects a broader dispute between pharmaceutical manufacturers and hospitals over how the 340B program should be managed.

3. Provider Organizations Rally Behind HHS: The healthcare provider community, including UMass Memorial Medical Center, Genesis HealthCare System, and trade group 340B Health, has been granted permission to intervene in the case. Leading hospital associations have also filed legal briefs in support of the government’s position, arguing that the drugmakers’ proposed rebate model threatens the financial stability of hospitals that rely on 340B discounts.

How healthcare organizations can decide which AI is worth implementing

By Caroline Catherman - It’s easy to get drawn in by flashy uses of AI in healthcare. It’s much harder to figure out which ones are actually good ideas and which ones just sound cool. “People like to fall in love with AI…and then suddenly [you] realize, wow, it costs a lot of money, and it’s more complex than we thought, and our scope creep is real. And suddenly, your project is failing,” Kathleen Walch, director of AI engagement and learning at Project Management Institute, a professional membership and training organization, told Healthcare Brew. Read Full Article…

HVBA Article Summary

1. Prioritize Data Quality Before AI Implementation: AI models are only as effective as the data they are trained on. Poor data quality—due to mislabeling, lack of organization, or insufficient governance—can lead to inaccurate AI outputs, as seen in flawed Covid diagnostic models. Establishing a solid data foundation, such as a master patient index, is essential for ensuring reliable AI performance.

2. Start Small and Iterate for Success: Instead of launching large-scale AI projects, organizations should begin with small, manageable applications. For example, a healthcare chatbot should initially focus on answering a single frequently asked question before expanding its capabilities. Measuring effectiveness at each stage helps refine the AI system and ensures meaningful impact.

3. Avoid Overambition Without a Clear Execution Plan: Large-scale AI initiatives that lack clear, incremental goals can lead to failure, as illustrated by IBM Watson for Oncology. Unrealistic expectations and inadequate data contributed to its downfall. A more strategic approach—starting with a narrow application and gradually expanding—can prevent costly missteps.

Optum Rx to eliminate prior authorization for 80 drugs

By Alexandra Murphy - Optum Rx, the pharmacy benefit manager under UnitedHealth Group, will remove prior authorization requirements for approximately 80 prescription drugs, aiming to streamline access for patients with chronic conditions. Read Full Article…

HVBA Article Summary

1. Reduction in Reauthorizations: The policy change is expected to reduce reauthorization requirements by 25%, significantly easing administrative burdens for providers and improving medication access for patients. This adjustment will impact over 10% of the company’s pharmacy network, reflecting a substantial shift in its approach to prior authorizations.

2. Broader Effort to Streamline Access: This initiative is part of UnitedHealth’s larger strategy to simplify healthcare access and reduce administrative hurdles. In 2023, the insurer cut prior authorization requirements by 20%, and in 2024, it introduced a gold card program, allowing certain providers to bypass prior authorization for select services. These measures aim to enhance efficiency and improve patient care delivery.

3. Expansion to Home Health Services: Beginning in April 2025, Optum Home & Community Care, formerly known as NaviHealth, will remove prior authorization requirements for home health services under Medicare Advantage and dual special needs plans across more than 30 states. This move is expected to improve care coordination, expedite services for vulnerable populations, and reduce delays in accessing essential home healthcare.

Actual small-group health premiums rise 6.1%

By Allison Bell - Small-group health insurance premiums are still going up at about the same rate as before, and the enrollee count continues to fall. A government agency that tries to protect plans with unusually sick enrollees published the numbers in a new report. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Premium Increase & Enrollment Decline: The average monthly premium for small-group health insurance rose by 6.1% in 2024 to $659, a slight decrease in the rate of increase compared to 6.2% in 2023. Meanwhile, enrollment dropped by 5.5%, reaching about 8.6 million enrollees, following a 6.9% decline in 2023.

2. Risk-Adjustment Program Role: The Center for Consumer Information and Insurance Oversight (CCIIO), under CMS, compiles these figures to support the Affordable Care Act (ACA) risk-adjustment program, which redistributes funds from insurers with lower-risk enrollees to those with higher-risk members.

3. State-Level Variations: Small-group monthly premiums varied significantly by state, from $445 in Mississippi to $1,048 in Ohio. California had the largest fully insured small-group market, with approximately 2 million enrollees.

A law in New York pushes doctors to be upfront about patients' costs

By Michelle Andrews - The routine is familiar for most people: When checking in for an appointment with a doctor or other health care provider, patients typically complete and sign a pile of paperwork, including a form that contains some version of the statement, "I agree to pay for all charges not covered by my insurance company." Read Full Article…

HVBA Article Summary

1. Patient Financial Risks and Consent-to-Pay Forms: Many patients feel pressured to sign open-ended financial consent forms before receiving medical treatment, even without knowing the costs involved. This practice often leads to unexpected medical bills and financial hardship, putting consumers at risk of medical debt.

2. New York's Legal and Policy Struggles: A state law enacted last fall aimed to prevent requiring patients to sign such consent-to-pay agreements before discussing costs. However, provider groups pushed back, citing payment and logistical challenges. The law's implementation was delayed indefinitely, and the governor’s 2026 budget proposal seeks to reinstate some form of pre-treatment financial agreements while maintaining the requirement for cost discussions.

3. Ongoing Debate on Medical Debt Protections: While some patient advocates argue that even a mandatory cost discussion is insufficient to protect consumers from financial liability, providers contend that discussing precise costs in advance is difficult due to insurance complexities. Additional consumer protection laws, such as restrictions on medical credit card practices, remain in effect, but the broader debate over fair billing and financial consent continues.

District Court Follows Trend of Requiring More Specificity in Health Benefit Denials

By Peter Sessions - Our case of the week is a published district court decision that tackles two important issues in ERISA benefits litigation. The first is a classic procedural issue that often bedevils parties, and the second involves the increasingly scrutinized question of what constitutes an adequate health benefit denial under ERISA. Read Full Article…

HVBA Article Summary

1. Procedural Determinations on Summary Judgment and Standard of Review: The court first addressed whether the case should be resolved through summary judgment under Federal Rule of Civil Procedure 56 or by a bench trial under Rule 52. It ruled in favor of summary judgment, emphasizing that fact-finding under Rule 52 would only be necessary if genuine issues of material fact remained after summary judgment review. Additionally, the court declined to decide whether the case should be reviewed de novo or under an abuse of discretion standard, stating that even under the more deferential standard, the denial of benefits was arbitrary and capricious.

2. Aetna’s Failure to Consider a Single Case Agreement Exception: While Aetna correctly noted that the plaintiff’s son's treatment was out-of-network, the court found that Aetna failed to properly consider the plaintiff’s request for a “single case agreement,” an exception under the plan for cases where in-network options are inadequate. The court determined that Aetna’s denial letters did not engage with this argument, thereby failing to provide a reasoned decision as required under ERISA.

3. Violation of ERISA’s Notice and Fair Review Requirements: The court ruled that Aetna violated ERISA by failing to provide adequate notice of the denial’s specific reasons and by not conducting a “full and fair review” of the appeal. Aetna’s argument that its broader administrative record justified the denial was rejected, as the court emphasized that post hoc justifications could not compensate for insufficient explanations in the denial letters. Consequently, the court remanded the case for further administrative review, instructing Aetna to specifically address whether the plaintiff’s son qualified for a single case agreement.

Senolytics: Zombie Cells, Longevity, and What’s Possible

By Sarah Amandalore - For many people, living longer brings health challenges: Osteoporosis, diabetes, Alzheimer’s disease. And of course, zombie cells. The technical term is senescent cells. They’re damaged and unable to repair themselves. They’re also more likely to linger in the body as we age — like zombies — secreting inflammatory molecules that can hasten our decline. Read Full Article…

HVBA Article Summary

1. Senolytics as a Therapeutic Breakthrough: Senolytics, experimental drugs that target and eliminate senescent cells, have shown promise in treating age-related diseases such as osteoarthritis, Alzheimer’s, and macular edema. Early trials, including the use of D+Q (dasatinib and quercetin) and foselutoclax, indicate potential benefits in improving physical function and tissue regeneration.

2. Challenges in Targeting Senescent Cells: The heterogeneity of senescent cells complicates treatment, as these cells vary by tissue type and function. While some senescent cells contribute to inflammation and degeneration, others aid in tumor suppression and wound healing. Researchers are working on refining senolytic therapies to selectively target harmful senescent cells while preserving beneficial ones.

3. Future of Senolytics and Aging Interventions: The field is moving toward a combination approach, with different senolytics potentially forming personalized treatment “cocktails” for specific conditions. While the FDA does not yet classify aging as a disease, initiatives like ARPA-H’s PROSPR program may pave the way for broader applications. Meanwhile, exercise remains a proven, natural way to reduce senescent cell burden and promote healthy aging.