Veterans became eligible for billions. These firms saw a chance to profit.

By Lisa Rein - Senators savored the moment on a summer day outside the Capitol — the passage of a sweeping, bipartisan agreement to add $280 billion in new benefits and health care for millions of veterans exposed to toxic burn pits. Read Full Article…

HVBA Article Summary

1. Exploitation Amid Success: Despite the widespread popularity of the Honoring our Pact Act, which has seen over 1 million disability claims approved, glitches and inefficiencies in the Department of Veterans Affairs rollout have enabled the growth of an unregulated industry. Predatory for-profit companies, charging exorbitant fees, promise to boost disability checks in exchange for veterans signing away future benefits, raising concerns among lawmakers and advocates.

2. Legal Loopholes and Industry Growth: Around 100 unaccredited for-profit companies, charging fees ranging from $5,000 to $20,000, have emerged, capitalizing on the VA's overwhelmed system and lack of enforcement powers. Despite federal laws prohibiting charging veterans for claims assistance, loopholes in legislation and diminished penalties have emboldened these companies. Now, a push by some lawmakers, supported by a well-funded industry group, aims to remove existing restrictions altogether.

3. Veterans Caught in the Middle: Veterans, seeking rightful benefits, face a complex landscape. While accredited nonprofit groups provide free services, they struggle to keep pace with VA bureaucracy. As a result, many veterans turn to for-profit companies enticed by promises of success rates and aggressive marketing tactics. However, these companies often fall short on promises, engaging in unethical practices and potentially jeopardizing legitimate claims, leaving veterans vulnerable to financial exploitation and legal ramifications.

Here are the Five Areas the New DOJ Task Force on Monopolies in Health Care Should Focus On

By Wendell Potter - Earlier this month, the U.S. Department of Justice announced it has launched an investigation into “issues regarding payer-provider consolidation” along with other problems associated with mergers and acquisitions in health care. This is significant. Read Full Article…

HVBA Article Summary

1. Insurers' Acquisition of Physician Practices: The task force will scrutinize insurers' increasing ownership of physician practices, which creates conflicts of interest and restricts competition. With UnitedHealth leading the trend, other insurers like CVS/Aetna and Elevance (formerly Anthem) are following suit, raising concerns about market consolidation and unfair practices such as kicking non-owned physicians out of networks.

2. Consolidation of Pharmacy Benefit Managers (PBMs) with Insurers: The task force will investigate the co-mingling of PBMs with health insurance companies, notably CVS/Aetna (Caremark), UnitedHealth (Optum Rx), and Cigna (Express Scripts), controlling 80% of the market. This consolidation adversely affects independent pharmacists and raises prescription drug costs, highlighting the need for transparency and regulation to ensure fair competition and patient access to medications.

3. Impact of Prior Authorization Requests: Insurers' aggressive use of prior authorization to limit claims payments will face scrutiny, especially as they seek to offset financial losses and control costs. This practice, criticized as "medical injustice disguised as paperwork," disproportionately affects patients and care delivery. Task force attention could catalyze legislative efforts to rein in excessive prior authorization and protect patient rights.

4. Rising Out-of-Pocket Costs: The task force aims to address the oligopoly of insurers driving up out-of-pocket costs and premiums. By focusing on price fixing, collusion, and transparency in healthcare costs, it seeks to empower consumers and mitigate the financial burden imposed by insurers, particularly through high-deductible plans.

5. Enforcement of Legislation like the No Surprises Act: Highlighting insurers' non-compliance with legislation such as the No Surprises Act, the task force underscores the need for clear rules and robust enforcement mechanisms in healthcare. Insurers' disregard for regulations, despite clear directives from Congress and CMS, exemplifies the unchecked power wielded by monopolistic entities, necessitating stringent oversight to protect consumer interests and uphold legal standards.

Wyden pushes for CMS to crack down on broker misbehavior

By Paige Minemyer - A key senator is calling on the Centers for Medicare & Medicaid Services (CMS) to crack down on brokers who submit fraudulent enrollments for Affordable Care Act (ACA) plans. Read Full Article…

HVBA Article Summary

1. Concerns Over Unauthorized Plan Changes: Senator Ron Wyden highlights reports of brokers making enrollments or alterations to healthcare plans without obtaining consent from the enrollees. These actions have resulted in tangible harm, including uncovered medical expenses, loss of coverage, disruptions in care, and unexpected tax liabilities for individuals.

2. Call for Enforcement and Accountability: Wyden urges the Centers for Medicare & Medicaid Services (CMS) to enforce civil monetary penalties for brokers engaging in fraudulent plan submissions, as stipulated in the Affordable Care Act (ACA). Additionally, he proposes legislative measures to hold such brokers criminally accountable.

3. Demand for Enhanced Regulatory Guidance: Senator Wyden emphasizes the necessity for CMS to establish clear guidance outlining acceptable marketing practices within the healthcare marketplace. This initiative aims to safeguard access to affordable health coverage and prevent exploitation by fraudulent actors seeking to gain illicit commissions.

HHS to Invest $50M in Cybersecurity for the Healthcare Industry

By Pietje Kobus - The Advanced Research Projects Agency for Health (ARPA-H), a Department of Health and Human Services (HHS) agency, announced in a news release on May 20 the launch of the Universal PatchinG and Remediation for Autonomous DEfence (UPGRADE) program. This effort will invest over $50 million in tool creation for cybersecurity in healthcare systems. Read Full Article…

HVBA Article Summary

1. Enhanced Security Measures: UPGRADE aims to revolutionize cybersecurity in healthcare by proactively identifying vulnerabilities within digital hospital environments. By utilizing advanced probing techniques, the program enables early detection of potential threats, allowing for timely patching and minimizing operational disruptions.

2. Streamlined Protection Efforts: Andrew Carney, the program manager of UPGRADE, emphasizes the initiative's commitment to reducing the complexity of securing hospital equipment. By facilitating efficient testing and implementation of patches, UPGRADE enables healthcare providers to prioritize patient care while ensuring the safety and functionality of critical devices.

3. Addressing Industry Challenges: The healthcare sector faces escalating cybersecurity risks, as evidenced by recent data breaches affecting prominent organizations like Change Healthcare and Ascension. Recognizing the urgent need for robust cybersecurity measures, HHS Deputy Secretary Andrea Palm underscores UPGRADE's significance in fortifying the nation's healthcare ecosystem. By aligning with HHS' Healthcare Sector Cybersecurity Strategy, UPGRADE seeks to empower hospitals of all sizes to navigate the evolving threat landscape with resilience and adaptability.

High drug costs and shortages threaten care quality, AHA warns

By Ashleigh Hollowell - Drugmaker price hikes that have occurred in tandem with ongoing drug shortages have not only created headaches for both hospitals and providers  — but also jeopardized patient access to care, according to an analysis published May 22 by the American Hospital Association. Read Full Article…

HVBA Article Summary

1. Impact on Hospitals: Between 2022 and 2023, around 85% of hospitals reported critical or moderate effects due to a combination of drug shortages and price hikes surpassing inflation rates. This situation severely strains hospital resources and directly affects patient care.

2. Escalating Drug Shortages: In 2023, hospitals encountered the highest number of drug shortages in 23 years, with generic drugs constituting approximately 83% of these shortages. This scarcity compels hospitals to seek alternatives, renegotiate contracts, or find new suppliers, elevating their expenditure on drugs by about 20%.

3. Rising Costs and Patient Outcomes: The average increase of 15.2% in drug prices, coupled with a 35% surge in the median annual price for new drugs in 2023 to $300,000, directly impacts hospitals' financial burdens. These escalating costs, along with persistent drug shortages, compromise patient access to essential care, posing a significant challenge to the sustainability of healthcare systems.

Health Savings Account Asset Growth Booming

By Brian Anderson - Supported by stock market tailwinds, Health Savings Account assets saw record growth in 2023, according to findings of the most recent HSA survey and research report from Devenir, a national leader in providing investment solutions for HSAs. Read Full Article…

HVBA Article Summary

1. Significant Growth in HSA Assets and Accounts: The report reveals a substantial increase in Health Savings Account (HSA) assets, reaching $123 billion by the end of 2023, marking a 19% year-over-year growth. The number of accounts also saw a notable rise, with over 37 million HSAs recorded, representing a 5% increase from the previous year. These figures underscore the growing popularity and adoption of HSAs as a savings tool for healthcare expenses.

2. Positive Projections for HSA Market Expansion: Projections indicate a continued upward trend in the HSA market, with expectations to reach approximately 44 million accounts and $168 billion in assets by the end of 2026. Jon Robb, SVP of research and technology at Devenir, emphasizes the promising trajectory, suggesting a steady and significant expansion of the HSA market in the foreseeable future. This outlook reflects confidence in the enduring appeal and effectiveness of HSAs as a financial instrument.

3. Dynamic Landscape of HSA Investments and Contributions: The report highlights dynamic shifts within the HSA landscape, particularly in investment activities and contribution trends. HSA investment assets rebounded notably in 2023, experiencing a 37% growth despite challenges in the stock market. However, the rapid growth in HSA investments observed in previous years has tapered off, with approximately 8% of all accounts having invested portions of their HSA dollars. Additionally, withdrawal activity surged in 2023, with $39 billion withdrawn from accounts, signaling increased utilization of HSA funds. Despite these fluctuations, the average balance in HSAs has risen, reflecting the sustained financial health and utilization of these accounts. Moreover, recent IRS announcements indicate slight increases in contribution limits for 2025, further enhancing the attractiveness and flexibility of HSAs for individuals and families seeking tax-advantaged healthcare savings options.

Benefits managers' attitudes on obesity influences employee access to care

By Alan Goforth - Recognizing obesity as a chronic disease and not a personal responsibility is a critical first step to ensuring that employees can access the full scope of evidence-based obesity care options, a recent study from the University of Pennsylvania found. Read Full Article…

HVBA Article Summary

1. Recognition of Obesity as a Chronic Disease: For over a decade, obesity has been acknowledged as a treatable chronic disease, paralleling care for other chronic illnesses. Despite this, less than half of employers currently cover or consider covering the latest anti-obesity medications, demonstrating a need for more comprehensive support.

2. Economic and Equity Implications: Obesity's impact extends beyond health, affecting economics and equity in the workplace. In 2023, it cost U.S. businesses and employees $425.5 billion. Moreover, obesity-induced health-related absences and disability costs increased by $134 million in 2022, alongside a reduction of economic activity by $1.3 billion. Notably, obesity disproportionately affects women, particularly women of color, contributing to weight bias that hinders their career advancement and earning potential.

3. Role of Employers in Promoting Obesity Care: Employers play a pivotal role in addressing the multifaceted challenges posed by obesity. By reforming attitudes, recognizing obesity as a chronic disease, and offering tailored benefits, they can improve employee health, productivity, inclusivity, and overall wellbeing. Creating a culture of health and wellbeing in the workplace, along with strategic benefits design, can promote access to evidence-based obesity care, mitigating the negative impacts of weight-based stigma and bias.

Latest 340B ruling delivers blow to providers

By Sydney Halleman - Providers and drugmakers have been at odds for years over the 340B Drug Pricing Program, which requires drugmakers to give discounts to providers that care for a disproportionate number of low-income populations. Read Full Article…

HVBA Article Summary

1. Legal Victory for Drugmakers: The recent appeals court ruling validates the right of pharmaceutical companies to impose limitations and conditions on pharmacies receiving discounted drugs under the 340B program. This decision overturns previous federal government threats of fines for non-compliance with guidance on pharmacy selection, marking a significant win for drug manufacturers like Novartis Pharmaceuticals and United Therapeutics.

2. Concerns Over Program Abuse: Pharmaceutical companies argue that some healthcare providers exploit 340B discounts by partnering with numerous pharmacies, potentially leading to duplicate discounts and misuse of the program's benefits. This concern is supported by reports indicating a substantial increase in contracted pharmacies since 2010, raising questions about oversight and the proper use of discounts.

3. Impact on Patient Access and Provider Discontent: While the court ruling permits drugmakers to set conditions for pharmacy distribution, it sparks criticism from provider groups like the American Hospital Association and America's Essential Hospitals. They argue that such restrictions hinder patient access to discounted medications and jeopardize care for vulnerable populations, highlighting ongoing tensions between drugmakers and healthcare providers over the interpretation and implementation of the 340B program.

Brain Risks Drop When Diet Includes More Minimally Processed Foods

By Judy George - A diet high in ultra-processed foods upped the risk of cognitive impairment or stroke, data from the prospective REGARDS study showed. Read Full Article…

HVBA Article Summary

1. Impact of Ultra-Processed Foods: Consuming a diet high in ultra-processed foods significantly increases the risk of cognitive impairment and stroke. A 10% increase in relative intake of ultra-processed foods raised the risk of cognitive impairment by 16% and stroke by 8%.

2. Benefit of Unprocessed or Minimally Processed Foods: Conversely, individuals who consumed more unprocessed or minimally processed foods experienced a reduction in the risk of cognitive impairment and stroke. A 10% increase in such foods lowered the risk of cognitive impairment by 12% and stroke by 9%.

3. Racial Disparity and Health Implications: The study revealed a greater impact of ultra-processed foods on stroke risk among Black participants compared to white participants, highlighting potential health disparities. The findings underscore the importance of considering not only the type of food consumed but also the level of processing in promoting brain health and mitigating neurological risks.

Semaglutide Aids Weight Loss With or Without Bariatric Surgery

By Damian McNamara, MA - Meaningful weight loss was seen with the weight loss drugs Wegovy or Ozempic regardless of whether people had previous weight loss surgery, a first-of-its-kind study reveals. Read Full Article…

HVBA Article Summary

1. Insurance Barriers: The primary obstacle preventing individuals from starting GLP-1 receptor agonists such as semaglutide was insurance coverage or the cost of the medication. This issue affected a significant portion of patients, with 72% citing it as a reason for not initiating treatment.

2. Challenges in Medication Continuation: Even among those who began taking semaglutide, discontinuation rates were notable. Factors such as insurance coverage and cost remained significant, but side effects and drug shortages also contributed to the decision to stop the medication. Notably, 36% of patients who ceased semaglutide cited side effects as the reason.

3. Discrepancy in Real-World Effectiveness: Real-world weight loss outcomes differed from those observed in clinical trials, indicating a potential gap between controlled research settings and practical application. While clinical trials often report weight loss of up to 15%, individuals in this study experienced a more modest average weight loss of 6%. This suggests the need for realistic expectations regarding the efficacy of medications like semaglutide outside of controlled research environments.