Cigna Reports Q1 Gains, Announces ACA Marketplace Exit

By Wendell Potter – Cigna reported its first-quarter 2026 results last Thursday. Like most of the other big health insurance conglomerates that have reported so far, it did a better job of meeting Wall Street’s profit expectations in the first three months of the year than it did in all of 2025. Total revenues rose 5% to $68.5 billion. Adjusted income from operations came in at $2.1 billion, or $7.79 per share — up 12% from a year ago, though missing analyst estimates by five cents. Read Full Article...

HVBA Article Summary

1. Cigna's Financial Performance and Strategic Shifts: Cigna reported a 5% increase in total revenues for Q1 2026, with adjusted income from operations rising 12% compared to the previous year. Despite these gains, the company announced it will exit the Affordable Care Act (ACA) Marketplace after the 2026 plan year, affecting 369,000 members across 11 states. This move is part of a broader trend among major insurers withdrawing from ACA exchanges, citing challenges in achieving scale and profitability.

2. Potential Impact on ACA Marketplace Stability: The departure of Cigna, following similar exits by other insurers like Aetna and Baylor Scott & White, is expected to leave at least half a million people searching for new coverage or potentially going uninsured. The article highlights that the expiration of enhanced premium tax credits has already led to a decline in ACA sign-ups and a sicker, smaller risk pool, which could trigger a cycle of rising premiums and further insurer withdrawals. This dynamic raises concerns about the long-term viability of the ACA Marketplace and the risk of a so-called "death spiral."

3. Questions Around Medical Loss Ratio and Industry Practices: Cigna's medical loss ratio (MLR) dropped from 82.2% to 79.8% year-over-year, meaning the company paid out a smaller percentage of premiums on patient care, which contributed to its strong earnings. The article notes that analysts did not ask whether this decline was related to changes in prior authorization practices or ongoing litigation involving Cigna's pharmacy benefit manager, Express Scripts. The lack of scrutiny on these issues suggests that investor priorities may not align with concerns about patient access and market stability.

SIIA Government Relations Update 5.4.2026

By Self-Insurance Institute of America – After 76 days, Congress ended the longest shutdown of a Federal Department in history, agreeing to fund – through Sept. 30th of this year – the Department of Homeland Security (DHS), minus funding for ICE and Border Control. As we all read in the news – and many of you likely experienced – the early weeks of the shutdown resulted in TSA employees missing paychecks, which then led to long lines at specified airports. The Trump Administration stepped in and started paying TSA employees with funds that were appropriated to DHS last Summer through the One Big Beautiful Bill. Read Full Article...

HVBA Article Summary

1. Healthcare Policy Activity Continues Despite Broader Legislative Focus: While reconciliation discussions center on federal funding issues, congressional committees remain actively engaged in healthcare policy. Lawmakers are examining prescription drug pricing, pharmacy benefit manager (PBM) structures, and how service providers are compensated. These ongoing efforts reflect sustained attention to cost transparency and oversight in the healthcare system.

2. Regulatory Efforts Target Transparency and Billing Practices: Federal agencies are advancing proposed regulations to improve transparency in healthcare, particularly requiring PBMs and potentially third-party administrators to disclose compensation to plan fiduciaries. At the same time, policymakers are working to address challenges in the surprise billing system, including concerns about arbitration outcomes and inefficiencies in the dispute resolution process. Proposed updates aim to streamline processes, reduce ineligible claims, and improve communication through new digital platforms.

3. State-Level Healthcare Policy Developments Expand Focus: Several states are pursuing healthcare-related policy changes to address coverage gaps and system costs. Proposals include creating state-funded subsidy programs, regulating stop-loss insurance, and assessing employers that do not offer affordable coverage. These initiatives highlight continued experimentation at the state level to manage healthcare affordability, access, and insurance market stability.

Brokers must audit network reliability in a digital-first era

By Daniel Cecalacean – Back when I ran data center operations, the worst calls always came at the worst hours. Something had gone sideways, somebody was getting woken up, and the clock was running on real consequences. That was a long time ago, and the stakes were high then. In health care today, those same kinds of calls carry a different weight entirely, because the thing on the other end of the outage is not a transaction queue. It is a patient waiting for care. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Increasing Complexity and Risk in Health Care Networks: The shift to digital health care, including telehealth and cloud-based records, has improved access and care delivery but also introduced new risks. Greater connectivity means more potential points of failure, making network reliability a critical concern for both patient safety and operational continuity. Health care organizations must now treat infrastructure resilience as a core part of their service delivery.

2. Resilience Requires Proactive Strategies and Collaboration: The most successful organizations are those that invest in proactive planning, redundant infrastructure, and honest assessments of their vulnerabilities. Benefits advisors play a key role by ensuring that resilience is part of vendor selection and contract negotiations, even if they are not directly responsible for IT systems. Collaboration between IT, HR, and benefits teams is essential to identify dependencies and ensure continuity planning is robust.

3. Practical Steps Can Mitigate Disruption Impact: Organizations can strengthen resilience by including network reliability in vendor discussions, making continuity expectations explicit in contracts, and regularly reassessing digital care platforms. Proactive monitoring, automatic failover systems, and centralized visibility across locations are hallmarks of best-in-class infrastructure. These measures help minimize downtime, maintain access to care, and protect both clinical and administrative workflows from disruption.

Has the health coverage-employment decoupling moment arrived — and is AI a driver?

By Elizabeth Casolo – Sharon Williams, a management consultant who took over as president of the University of Michigan Health Plan as it wound down, thinks there is one imperative for tackling healthcare costs. “We will not be able to appropriately address cost until we uncouple healthcare from employment,” she said at the Becker’s Spring 2026 Payer Issues Roundtable in Chicago. A December survey from Talker Research, on behalf of Oscar Health, found health insurance is a top factor for Americans considering a career move. Still, one factor driving Ms. Williams’ argument is fragmented risk adjustment pools. Read Full Article...

HVBA Article Summary

1. Fragmented Risk Pools and Cost Challenges: The article highlights that tying health insurance to employment leads to fragmented risk pools, which can cause instability as people move in and out of jobs. Broader, more stable risk pools could help address volatility and potentially lower costs, but the current system’s structure makes this difficult. Experts argue that decoupling health coverage from employment is a necessary step to effectively manage healthcare expenses.

2. Impact on Income Inequality and Workforce Dynamics: Employer-sponsored health insurance is described as a significant driver of income inequality, since premiums are generally uniform across employees regardless of wage differences. This system places a disproportionate financial burden on lower-wage workers and can influence employer decisions about workforce retention, especially when healthcare costs rise. The rise of gig economy jobs and nontraditional employment arrangements is increasing pressure to reconsider the link between employment and health coverage.

3. AI’s Uncertain Role and Potential Policy Solutions: While some believe artificial intelligence could accelerate unemployment and thus push more people out of employer-sponsored insurance, current research shows mixed evidence about AI’s impact on job loss. Policy suggestions to address the decoupling include rolling back tax exclusions, providing tax-free employer contributions for individual insurance, and expanding ACA subsidies. However, experts caution that the current marketplace may not be equipped to handle a sudden influx of individuals seeking coverage independently, and that broader reforms may be needed as healthcare costs continue to rise.

A deeper dive into the ACCESS Model—Who’s participating, potential headwinds and how it could spur health plan adoption

By Heather Landi – The Trump administration is testing out a new 10-year program for value-based chronic condition management that leans heavily on technology and artificial intelligence to scale to large populations of patients. Many of the 150 digital health companies tapped to participate in the first cohort of the tech-enabled chronic care model are bullish that it marks an inflection point for connected care and a way to prove out that AI-enabled medical services can move the needle on cost and quality. The Center for Medicare and Medicaid Innovation (CMMI) announced in December the Advancing Chronic Care with Effective Scalable Solutions (ACCESS) Model as a 10-year payment program to encourage the use of technology to treat chronic diseases. Read Full Article...

HVBA Article Summary

1. ACCESS Model’s Focus on Technology and Outcomes: The ACCESS Model is designed to shift Medicare chronic care management toward technology-driven, outcome-based payment structures. By eliminating traditional billing codes and introducing outcome-aligned payments, the program aims to incentivize the use of digital health tools and artificial intelligence for managing conditions like diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety. This approach is intended to make value-based care more scalable and accessible to a broader patient population.

2. Mixed Industry Response to Payment Rates and Participation: While 150 organizations, including digital health startups and device makers, are participating in the first cohort, several large, established digital health companies opted out due to concerns over low reimbursement rates. Some executives argue that the current payment levels may not cover the costs of delivering high-quality care, potentially limiting participation from providers with proven care track records. The payment structure is expected to push participants to maximize efficiency through technology and AI, but it also raises questions about the financial sustainability for some organizations.

3. Potential to Influence Broader Health Plan and Employer Adoption: The ACCESS Model has already prompted commercial payers representing millions of members to consider aligning with its payment approach, signaling possible ripple effects beyond Medicare. There is growing interest from employer-sponsored health plans in adopting similar value-based, tech-enabled care models, especially as federal agencies emphasize prevention and outcomes. Success of the ACCESS Model could accelerate the adoption of digital health and AI-driven care management across both public and private sectors, though integration with primary care and responsible implementation remain critical challenges.

How disintermediation is being managed in Rx models

By Ryan Czado – Fewer employers are relying on a traditional pharmacy benefit manager (PBM) model to run their entire Rx program. Use of transparent PBMs among employers increased to 31% in 2025 last year from 12% in 2024, according to the National Alliance of Healthcare Purchaser Coalitions. For brokers and consultants, this shift shows up across the book of business as a move toward disintermediation. In practice, plan sponsors are unbundling the traditional PBM model and moving to a multi-vendor configuration, whether that means changing PBM contracting structures, carving out specialty management, or layering clinical navigation and other partners alongside the PBM. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Shift Toward Transparent and Multi-Vendor Models: Employers are increasingly moving away from traditional PBM models in favor of transparent PBMs and multi-vendor configurations. This shift allows plan sponsors to unbundle services, providing more choice and control over pharmacy benefits. However, it also introduces complexity in measurement and reporting, as multiple vendors and partners must be coordinated.

2. Role of Neutral-Optimization Layers: The article highlights the importance of a neutral-optimization layer that works alongside PBMs and other pharmacy partners. This layer helps identify clinically appropriate, lower-cost alternatives and reduces waste, such as duplicate therapies or unnecessary high-cost prescriptions. By consolidating data and recommendations, it enables brokers and consultants to present clear, renewal-ready reports that document savings and performance.

3. Challenges in Accountability and Measurement: Disintermediation spreads accountability across several partners, making it difficult to reconcile performance and financial guarantees into a single, defensible outcome. Brokers and consultants must bridge gaps between disparate reports and timelines to provide employers with a unified view of net costs and trend drivers. The article suggests that setting clear measurement paths and ensuring transparency in savings calculations are critical for managing these challenges effectively.

Menopause, GLP-1s, and Weight Loss in the Real World

By Marilynn Larkin – Women ages 50-64 were the highest users of GLP-1s for weight management in 2025, with 20% reporting current or past GLP-1 use, according to RAND American Life Panel research. Yet this population has been largely ignored in studies of the drugs' risks and benefits, noted the authors of a recent commentary. This "striking disconnect" echoes decades of women being overlooked by medical research, wrote RAND staff members Katherine M. Rancaño and Shannon D. Donofry in their commentary. Read Full Article...

HVBA Article Summary

1. Lack of Research on GLP-1 Use in Menopausal Women: Despite being the highest users of GLP-1 medications for weight management, women aged 50-64 are underrepresented in clinical studies evaluating these drugs' safety and efficacy. This gap leaves both patients and healthcare providers to make treatment decisions without robust, targeted evidence. The absence of data may result in uncertainty about optimal dosing, expected outcomes, and potential risks for this demographic.

2. Lifestyle Changes Remain Crucial for Sustainable Weight Loss: Experts emphasize that while GLP-1 medications can aid weight loss, their effectiveness is maximized when combined with healthy lifestyle changes such as improved diet, increased physical activity, and strength training. Relying solely on medication without addressing underlying habits may lead to loss of muscle mass and eventual weight regain. A holistic approach, including counseling on nutrition and exercise, is recommended to support long-term health and minimize negative outcomes.

3. Need for Individualized and Evidence-Based Care: Clinicians are encouraged to tailor GLP-1 therapy to each patient's unique needs, considering factors like age, metabolic rate, and comorbidities. There is a call for more rigorous research, including randomized clinical trials, to clarify the benefits and risks of GLP-1s and hormone therapy in menopausal women. Until such evidence is available, providers must carefully weigh the potential advantages against unknowns and avoid prescribing these medications to women who do not meet established criteria for overweight or obesity.

FDA announces recall on insulin pump pods after leaks cause 29 serious injuries

By Chad Van Alstin – A recall on insulin pump pods has been designated by the U.S. Food and Drug Administration (FDA) as a Class I recall, the agency's most serious type after 29 serious injuries were reported. To date, there have been no deaths associated with the defective devices, manufactured by Massachusetts-based Insulet. However, certain lots of the Omnipod 5—used in an automated insulin delivery system for those with Type 1 diabetes—will need to be removed from where they are used or sold in order to prevent any potential fatalities. Read Full Article...

HVBA Article Summary

1. Nature of the Recall: The FDA has classified the recall of certain Omnipod 5 insulin pump pods as a Class I recall, indicating a high risk of serious injury or death if the devices are used. The recall was prompted by reports of 29 serious injuries linked to leaks caused by internal tube tears within the pods. While no deaths have been reported, the recall aims to prevent further harm by removing affected products from use and sale.

2. Device Malfunction and Risks: The defect in the recalled pods can cause insulin to leak, resulting in patients receiving less insulin than needed. This underdelivery can lead to elevated blood sugar levels and potentially trigger diabetic ketoacidosis, a dangerous condition requiring immediate medical attention. In some cases, the device may not alert the user to the problem, increasing the risk of unrecognized underdosing.

3. Recommended Actions for Patients and Providers: Patients using Omnipod 5 pods are advised to check if their devices are part of the recall by referencing the provided unique device identifier and the FDA's full list of affected products. Defective pods should not be used, and patients without replacements should consult their healthcare provider for alternatives. Insulet has set up a 24/7 service line to assist with returns and replacements, and the recall list has been updated to include additional units, making it important for users to verify all products in their possession.