UnitedHealth CEO Says Company is Cutting Thousand of Doctors Out of Network to Boost Profits

By Luke Sullivan – UnitedHealth Group announced last week that it plans to cut thousands of doctors from its network, a move CEO Stephen Hemsley said will increase profits for the country’s richest health care conglomerate. UnitedHealth assembled a network of nearly 90,000 physicians across the country as it bought hundreds of physician practices, began managing the Medicaid program in many states and became the biggest Medicare Advantage company. It also owns one of the nation’s largest pharmacy benefit managers, Optum Rx. Read Full Article...

HVBA Article Summary

1. Large-Scale Network Reduction for Financial Gain: UnitedHealth is planning to remove thousands of doctors from its network, despite having assembled nearly 90,000 physicians nationwide. Of these, fewer than 10,000 are directly employed by the company, and the move is explicitly intended to boost profits for UnitedHealth, which reported $4.3 billion in profit on $113 billion in revenue in the last quarter. This strategy is part of a broader effort to consolidate its physician network and focus on those aligned with its “value-based care” model.

2. Significant Market Presence and Patient Impact: UnitedHealth’s decision affects a vast number of Americans, with 29.9 million enrolled in its commercial plans, 8.4 million in Medicare Advantage, and 7.5 million in Medicaid programs. As the company controls or is affiliated with about 10% of U.S. doctors and has created or acquired nearly 2,700 subsidiaries, the reduction in network size could force many patients to seek new in-network providers or switch insurers. This consolidation may disrupt patient care and limit provider choice for millions.

3. Broader Industry Trend with Major Financial Stakes: UnitedHealth’s approach mirrors actions by other major insurers like CVS Health and Cigna, which reported revenues of $373 billion and $247 billion respectively. These companies are also restructuring provider networks and implementing cost-cutting measures to improve earnings. The industry-wide trend of narrowing networks and consolidating control over medical services is occurring alongside rising health care premiums, which increased by about 6% this year and are expected to rise further in 2026.

Medical inflation is top priority for employers as they wrestle with health costs

By Allison Bell – Executives at Aon and Arthur J. Gallagher say that the U.S. labor market still looks strong, but that big increases in U.S. health coverage costs are definitely getting employers' attention. At Aon, the health solutions unit increased revenue 6%. "This is a 20%-plus segment of the U.S. economy, and costs are growing at 9% to 10% a year," Aon Chief Executive Officer Greg Case told securities analysts Friday during a conference call. "It's a tremendous burden on companies." Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Employer Health Strategies and GLP-1 Drugs: Aon analysts reported that the smart, targeted use of GLP-1 agonist weight-loss medications could not only enhance the overall health of an employer’s workforce but also contribute to bending the long-term healthcare cost curve. This insight reflects a growing interest among benefits advisors, like Aon’s team, in integrating innovative clinical approaches into employee health strategies.

2. Medical Inflation as a Growing Concern for HR: According to Gallagher’s CFO Doug Howell, while traditional priorities like talent attraction and retention remain important, HR leaders are increasingly turning their attention to the pressing issue of medical inflation. This evolving focus is expected to generate new business opportunities for advisory firms, particularly as employers seek expert guidance to manage escalating healthcare costs heading into the next fiscal year.

3. Strong Financial Performance by Aon and Gallagher: Both Aon and Gallagher posted solid earnings growth for the third quarter of 2025, indicating resilience and strong demand for benefits advisory services. Aon’s net income rose to $470 million on $4 billion in revenue, while Gallagher reported $410 million in net income on $2.9 billion in revenue. These gains reflect the continued value employers place on professional support in navigating complex benefits and cost management challenges.

Senators have outline for drug price program, but vote is elusive

By Jessie Hellmann – Lawmakers impatient with the lack of progress on a key health care issue — the long-debated need for changes to what’s known as the 340B drug pricing program — say they are closing in on legislation aimed at what they say are abuses in the program. The program, established in 1992, requires drug companies to sell deeply discounted drugs to community health centers and hospitals that serve high numbers of low-income patients. These 340B providers spent $66 billion on discounted drugs in 2023. Read Full Article...

HVBA Article Summary

1. Ongoing Debate Over 340B Program Reform: Lawmakers from both parties are expressing frustration over the slow progress in reforming the 340B drug pricing program, which is intended to help low-income patients access affordable medications. While there is broad agreement that the program needs changes to address alleged abuses, consensus on specific legislative action remains elusive. The complexity of the issue and competing interests among hospitals, drug companies, and lawmakers have contributed to the legislative gridlock.

2. Draft Legislation and Key Proposals: A Senate working group has released draft legislation that would clarify requirements for drug companies to provide discounts through contract pharmacies and increase oversight of 340B providers. The draft also proposes stricter definitions and registration requirements for off-site provider locations and aims to define who qualifies as a 340B patient. These measures are intended to address concerns about transparency, eligibility, and the use of program savings, but have not yet advanced to a formal vote.

3. External Pressures and Uncertain Outlook: The Trump administration's proposed pilot to shift the 340B program to a rebate model has raised concerns among hospitals and community health centers about financial disruptions. This pilot, set to begin in January, could increase pressure on Congress to act, but ongoing government funding disputes make immediate legislative progress unlikely. Experts suggest that while action is possible in the next congressional session, significant movement on 340B reform is not expected this year.

Eli Lilly Says Weight-loss Pill a Candidate for Speedy Approval Under New US Program

By Mrinalika Roy and Patrick Wingrove – Eli Lilly said on Thursday its experimental weight-loss pill met most criteria for the U.S. Food and Drug Administration's new national priority voucher, suggesting it is a strong candidate for a significantly accelerated approval review. Lilly said it will submit its review package for the pill, orforglipron, to the FDA this quarter, adding the agency will decide on the approval process. In June, the FDA unveiled a program under which its commissioner can award vouchers to national‑priority drugs, shortening reviews to one to two months from about 10 to 12. Read Full Article...

HVBA Article Summary

1. Accelerated FDA Review Pathway: Eli Lilly's experimental weight-loss pill, orforglipron, is being considered for the FDA's new national priority voucher program, which can reduce the review time for qualifying drugs to as little as one to two months. The company claims the pill meets most of the program's criteria, including innovation and addressing unmet health needs. This could potentially bring the drug to market much faster than the typical 10-12 month review process.

2. Strong Clinical Results and Manufacturing Investment: Orforglipron demonstrated significant efficacy in clinical trials, with patients losing an average of 12.4% of their body weight in a late-stage study. Eli Lilly has also invested heavily in expanding its U.S. manufacturing capacity to support the anticipated demand for the drug. These factors strengthen the company's case for expedited approval and readiness for large-scale distribution.

3. Market Impact and Financial Performance: Eli Lilly continues to outperform market expectations, driven by robust sales of its weight-loss and diabetes drugs, Zepbound and Mounjaro, both of which share the same active ingredient as orforglipron. The company raised its profit and revenue forecasts for the year, citing strong international demand and minimal negative impact from recent formulary changes. The weight-loss drug market is highly competitive, with projections suggesting it could reach $150 billion by the end of the decade.

States lead effort to fix America’s long-term care crisis

By Susan Rupe – States are stepping up to respond to the need for long-term care services and supports in innovative ways. A panel looked at some of those strategies during the 2025 Harkin Institute Retirement Security Symposium. “What we are witnessing is the effects of an underfunded system,” said Marc Cohen, professor of gerontology at the LeadingAge LTSS Center, University of Massachusetts Boston. “The challenges we have with our caregiving workforce, our family caregivers, and so on all derive from the issue that we do not have a stable source of funding going into the LTSS (long-term services and support) system.” Read Full Article...

HVBA Article Summary

1. State-Level Innovation in Long-Term Care: States are increasingly taking the lead in addressing the challenges of long-term care, especially as federal action remains stalled. They are experimenting with a variety of strategies, such as strengthening the caregiving workforce, supporting family caregivers, expanding access and affordability, and encouraging private insurance solutions. These efforts reflect a recognition that the costs of inaction are becoming greater than the costs of intervention.

2. Workforce and Family Caregiver Support Are Central: Many states are implementing measures to bolster the long-term care workforce, including raising wages, standardizing training, and offering recruitment incentives. Simultaneously, there is a growing emphasis on supporting family caregivers through tax credits, paid leave policies, and respite services. These initiatives acknowledge that both professional and family caregivers are essential to sustaining the long-term care system.

3. Pilot Programs and Policy Debates Highlight Funding Challenges: Programs like Washington’s WA Cares Fund and California’s exploration of a statewide long-term care insurance model illustrate the diverse approaches states are considering. These programs aim to address inequities in access and support, but debates continue over how to fund such initiatives, whether through payroll taxes, employer contributions, or other mechanisms. The ongoing policy discussions underscore the complexity of creating sustainable, equitable long-term care solutions at the state level.

The hidden cost of complacency: Why employers should rethink 'safe' stop-loss provisions

By Scott Byrne – As policymakers debate the future of enhanced premium tax credits, millions of individuals risk losing marketplace coverage. If those credits expire, many will shift back into employer-sponsored plans, driving new cost pressures and volatility across the mid-market. In an effort to contain costs and limit financial volatility, employers have turned to rate caps and No New Laser provisions. On paper, they appear to achieve stability. In practice, they often do the opposite, spreading risk, masking volatility, and quietly eroding the performance of otherwise healthy captives. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Unintended Consequences of Rate Caps and No New Laser Provisions: While rate caps and No New Laser provisions are intended to provide predictability and stability for employers, they can actually undermine the effectiveness of captives. These mechanisms may spread risk unevenly and mask underlying volatility, leading to higher costs for proactive employers. Over time, this can erode the financial performance of captives and diminish the benefits for those who actively manage risk.

2. Importance of Accountability in Captive Structures: Captives that prioritize accountability and align responsibility with outcomes tend to outperform those that rely on blanket protections. When accountability is removed, proactive employers may end up subsidizing less engaged members, weakening group alignment and inflating renewals. Embedding accountability and coordinated risk management encourages early engagement, reduces volatility, and leads to more stable financial outcomes.

3. Rising Health Care Costs Demand Proactive Strategies: The landscape of employer-sponsored health care is becoming more complex due to increasing high-cost claims, particularly in areas like oncology, chronic kidney disease, and gene therapies. With specialty drug costs projected to rise significantly and the frequency of large claims increasing, employers cannot rely solely on traditional protections. Instead, adopting captives that emphasize transparency, shared responsibility, and proactive engagement is crucial for long-term sustainability and cost containment.

Talkspace sees growing role in obesity management, AI innovation

By Heather Landi – Online therapy provider Talkspace reported another strong quarter with 25% revenue growth, driven by its expanding payer business, with net income of $3.3 million, up 73% from the same period in 2024. The company brought in $59.4 million in revenue in Q3, driven by a 42% year-over-year increase in payer revenue,  or insurance-covered sessions, to reach $45 million. Talkspace's direct-to-consumer business, however, continued to decline, with $4.6 million in revenue, down 23% year-over-year. The company's direct-to-enterprise revenue was $9.3 million, down 1% year-on-year. Read Full Article...

HVBA Article Summary

1. Strong Financial Performance Driven by Payer Business: Talkspace experienced a 25% revenue growth in the third quarter of 2025, largely fueled by a 42% increase in payer revenue, which includes insurance-covered sessions. Despite declines in its direct-to-consumer and direct-to-enterprise segments, the company improved its adjusted EBITDA to $5 million, reflecting better profitability. This growth underscores the importance of payer partnerships in Talkspace's business model and its ability to scale within insurance networks.

2. Advancements and Investments in AI for Mental Health: Talkspace is heavily investing in artificial intelligence to enhance patient experience and provider efficiency. Their AI initiatives include smart evaluations, session summaries, and AI-powered risk algorithms, all designed to support clinicians and improve therapeutic outcomes. The company is also developing a proprietary large language model (LLM) trained on extensive anonymized therapy transcripts, aiming to offer a safer and more effective AI-supported mental health service compared to general-purpose chatbots.

3. Expansion into Pharma and Behavioral Health Integration: Beyond therapy services, Talkspace is exploring opportunities in the pharmaceutical space, exemplified by its partnership with Novo Nordisk to support patients using the Wegovy weight-loss drug. Through its social health platform Wisdo, Talkspace provides group coaching and emotional support to enhance patient adherence and outcomes. This diversification reflects Talkspace's strategy to broaden its impact on behavioral health by integrating digital support with medical treatments.