Battle Between Health Care Giants Puts Patient Access in Jeopardy

By Wendell Potter – We reported last week about a business practice Cigna has once again put in place to automatically downcode several procedures used by physicians for reimbursement purposes – a practice the company agreed to stop using as a condition of settling a massive class action lawsuit 21 years ago. This resurrected downcoding scheme will result in big cuts in pay for many of the country’s doctors but help the insurance conglomerate meet Wall Street’s profit expectations, something it hasn’t been doing this year. Read Full Article...

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1. Potential Network Disruption for Patients: Tenet Health has informed brokers and employer clients that negotiations with Cigna have stalled, threatening to remove Tenet’s 64 hospitals and nearly 370 ambulatory surgical centers (ASCs) from Cigna’s provider networks. This could reduce in-network access for hundreds of thousands of Cigna health plan enrollees, forcing them to travel farther or face higher out-of-pocket costs for outpatient care starting January 1, 2026. The timing is critical as open enrollment for commercial health plans is imminent, leaving little time for patients to adjust their coverage choices.

2. Financial Dispute Rooted in Reimbursement Rates: Tenet accuses Cigna of proposing contract terms that include annual rate increases below inflation and cuts to reimbursement for physician and ambulatory care access, despite Cigna reporting a 10% increase in premium revenue per member for employer-insured products. This dispute contrasts with the broader industry trend and Cigna’s own strategy to shift care to outpatient settings, which are typically less expensive than hospital care. If Tenet’s ASCs go out of network, patients may receive more care in hospitals, increasing costs for both Cigna’s employer customers and patients.

3. Wider Industry Context of Increasing Contract Disputes: The conflict between Cigna and Tenet reflects a larger pattern of rising disputes between insurers and providers in 2025, driven by insurers’ pressure to improve profit margins. According to FTI Consulting, there were 79 confirmed contract disputes as of September 1, many involving reimbursement and prior authorization issues. This trend is affecting not only commercial and Medicare Advantage plans but also Medicare beneficiaries, with some providers leaving insurer networks, potentially reducing patient access across various insurance types.

Anti-Obesity Medications Set to Explode Entering 2026

By Julie Peck – With the supply of GLP-1 medications finally stabilizing as their use skyrocketed 600% among Americans from 2018 to 2024, the pharmaceutical landscape for anti-obesity medications is now poised to undergo another monumental shift. A rapid proliferation of drugs that show an unprecedented efficacy for treating this disease is expected over the next year. Read Full Article...

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1. Emergence of Multi-Agonist Therapies: The next generation of anti-obesity medications is advancing beyond GLP-1 receptor agonists to include dual and triple agonists targeting multiple metabolic pathways. Drugs like tirzepatide (a dual GIP/GLP-1 agonist) and retatrutide (a triple agonist activating GLP-1, GIP, and glucagon receptors) demonstrate superior weight loss outcomes and metabolic benefits. These multi-targeted therapies offer a more comprehensive approach to weight management and are showing results comparable to bariatric surgery in clinical trials.

2. Innovations in Drug Delivery and Mechanisms: Oral formulations of GLP-1 receptor agonists, such as oral semaglutide, are progressing through trials, providing non-injectable options that may improve patient adherence. Additionally, novel mechanisms like Amgen’s maridebart cafraglutide, which acts as a GLP-1 receptor agonist and GIP receptor antagonist, offer promising efficacy with less frequent dosing schedules. These innovations aim to enhance accessibility, convenience, and long-term adherence to obesity treatments.

3. Personalized and Expanding Treatment Landscape: The diversification of anti-obesity medications with different mechanisms, side effect profiles, and dosing regimens allows for more personalized treatment strategies. Experts emphasize that obesity treatment is not one-size-fits-all, and having multiple therapeutic options enables clinicians to better match treatments to individual patient needs. This expanding arsenal of medications is expected to significantly impact the global obesity epidemic by providing safer, more effective, and tailored care.

LTCi makes a difference in family caregiving, study finds

By Susan Rupe – Caregiving can be expensive and chaotic. Having long-term care insurance can make a difference in how families deal with caregiving. That was the main takeaway from a recent study from the Certification for Long-Term Car e and UMass Boston’s LeadingAge LTSS Center. The study tracked four groups of families who are paying for in-home care, two with long-term care insurance and two without. Read Full Article...

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1. Long-Term Care Insurance Eases Financial Burden but Not All Stress: The study found that families with long-term care insurance (LTCi) experienced less financial strain compared to those without, as the insurance helped cover significant care costs. However, even with LTCi, families still faced substantial out-of-pocket expenses for daily living needs not covered by the policy. This highlights that while LTCi can mitigate some financial challenges, it does not eliminate all the pressures associated with caregiving.

2. Complexity and Communication Issues Limit LTCi Effectiveness: Many caregivers reported difficulty understanding LTCi policies, especially if they were not involved in the initial purchase. There was a notable lack of awareness about additional benefits such as respite care or care coordination, suggesting that insurers may not be effectively communicating policy features. This confusion can prevent families from fully utilizing the support available to them through their insurance.

3. Caregiver Challenges Persist Regardless of Insurance Status: Both insured and uninsured families struggled to find reliable caregivers and access supportive services. Those without LTCi often faced more severe financial consequences, including early retirement and depleted savings, but sometimes found greater satisfaction using independent caregivers rather than agency-based care. The study also revealed widespread anxiety about future long-term care planning, with many participants wishing they had received better education on the topic earlier.

What Americans think about rising health care costs, according to a new AP-NORC poll

By Ali Swenson and Linley Sanders - Most U.S. adults are worried about health care becoming more expensive, according to a new AP-NORC poll, as they make decisions about next year’s health coverage and a government shutdown keeps future health costs in limbo for millions. About 6 in 10 Americans are “extremely” or “very” concerned about their health costs going up in the next year, the survey from The Associated Press-NORC Center for Public Affairs Research finds — a worry that extends across age groups and includes people with and without health insurance. Read Full Article...

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1. Widespread Concern Over Rising Health Care Costs: The AP-NORC poll reveals that about 60% of Americans are extremely or very worried about increasing health care expenses in the coming year. This concern spans all age groups and affects both insured and uninsured individuals, highlighting a broad anxiety about affordability and access to necessary medical care and medications.

2. Impact of Government Shutdown and Policy Changes: The ongoing government shutdown has created uncertainty around future health care costs for millions, particularly concerning the expiration of Affordable Care Act subsidies. Additionally, recent federal policies, including significant cuts to health care and food assistance programs, are projected to result in millions losing health insurance coverage, exacerbating public fears about health care stability.

3. Political Divide and Trust in Health Care Management: The poll underscores a deep ideological split regarding the government's role in health care, with a majority of Democrats supporting federal responsibility for universal coverage, contrasted by fewer Republicans. Trust in political parties to handle health care effectively also varies, with many independents distrusting both parties, reflecting widespread skepticism about political solutions to health care challenges.

First local government adopts ICHRAs as a benefits solution

By Allison Bell – A small government employer is trying to solve its health benefits problems by putting its 265 employees in an individual coverage health reimbursement arrangement plan. The members of the Monongalia County, West Virginia, county commission approved the shift at a meeting last week. Read Full Article... ^{_{(Subscription required)}}

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1. Monongalia County is Pioneering ICHRA Use in Local Government: Monongalia County has contracted with Take Command to administer an Individual Coverage Health Reimbursement Arrangement (ICHRA), marking it as one of the first local government entities to adopt this innovative approach to employee health benefits. This move represents a significant departure from traditional group health insurance and signals a potential shift in how public employers manage health coverage.

2. ICHRA Aims to Address Coverage Challenges and Expand Employee Choice: The county has historically struggled to secure group health insurance due to its high volume of claims, with some carriers unwilling to offer proposals. By transitioning to an ICHRA model, the county can avoid the limitations imposed by group underwriting and instead offer employees access to 37 different plans from three insurance carriers, thus broadening their options and reducing institutional risk.

3. The Move Has Sparked Industry Attention and Mixed Reactions: While some local residents have expressed concern over possible increased costs to employees, Commissioner Sean Sikora has dismissed these criticisms as misinformation. Industry leaders, however, view the move as a notable development. Executives from competing firms and benefits providers see it as an early example of a growing trend, with ICHRA adoption spreading across various sectors including counties, schools, healthcare systems, and service industries.

AMA launches initiative in bid for AI policy leadership

By Emma Beavins – The American Medical Association (AMA) has created a Center for Digital Health and AI that it hopes will pave the way for thought leadership and policy on the technology. The AMA has long advocated that artificial intelligence in healthcare is augmentative and not able to replace physicians. The center will also help the group avoid becoming irrelevant in the discussion of AI and keep regulations physician-friendly. The nation’s largest physician association wields significant power in Washington, D.C., and helps decide what services and technologies get paid for in the industry. Read Full Article...

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1. AMA’s Strategic Move into AI Policy: The AMA is establishing its Center for Digital Health and AI to assert a leadership role in shaping policy and guidance for artificial intelligence in healthcare. This move comes as other organizations have already released their own AI frameworks, making the landscape competitive and crowded. The AMA aims to ensure that physicians’ perspectives are central to future AI regulations and standards.

2. Focus on Physician-Centric and Practical Issues: Unlike some existing groups, the AMA emphasizes a physician-first approach, seeking to address practical concerns such as clinical workflow integration, transparency, ethical disclosures, and liability. The center will also prioritize building trust among clinicians by increasing understanding of how AI tools function in daily practice. This focus is intended to make AI adoption more relevant and beneficial for healthcare providers.

3. Plans for Collaboration and Guidance Development: The AMA intends for the center to be active in producing guidance documents, hosting events, and collaborating with technology stakeholders. Leadership for the center will be recruited with the expectation of shaping its direction and assembling a dedicated staff. While the AMA is cautious about vendor dominance, it acknowledges the importance of including technology expertise in its discussions and leadership.

How to close the benefits gap for female workers

By Lee Hafner – Women are increasingly responsible for providing benefits and financial support to their families, but are frustrated with what's available through their workplace. Benefit managers play a key role in identifying and filling the gaps. Currently, fewer than 60% of women with a household income of less than $50,000 reported knowing enough about managing money, insurance and benefits, according to survey findings from financial solutions and insurance firm The Standard. Their research looked for correlations between income and benefits education and satisfaction. For example, those in higher income brackets reported being more savvy in these areas, but less satisfied with benefit options. Read Full Article... ^{_{(Subscription required)}}

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1. Women as Primary Benefit Providers: Two-thirds of women are the primary providers of benefits for their households, making them a critical demographic for targeted benefits communication and offerings. Despite this responsibility, many women, especially those in lower income brackets, report gaps in financial literacy and benefits education. Addressing these gaps is essential for improving their satisfaction and engagement with workplace benefits.

2. Importance of Tailored Financial and Caregiving Benefits: Research indicates that 61% of women are actively seeking to improve their financial knowledge, highlighting the value of benefits that support financial education. Additionally, caregiving support remains inadequate for many women, with economic reasons limiting family expansion for some. Employers can address these issues by offering voluntary benefits such as financial counseling, insurance options, tuition reimbursement, and enhanced caregiving and leave policies.

3. Role of Employee Resource Groups and Feedback: Employee resource groups (ERGs), surveys, and focus groups are effective tools for identifying the benefits needs and preferences of female employees. These channels facilitate peer-to-peer education and help employers gather insights that can lead to the adoption of new or improved benefits. Engaging women employees directly ensures that benefit offerings are relevant and can enhance attraction, engagement, and retention.