Study suggests No Surprises Act protections are reducing patients' out-of-pocket costs

By Paige Minemyer – While data released earlier this week raised questions about the administrative costs associated with No Surprises Act (NSA) arbitrations, a second study suggests the legislation is working to reduce out-of-pocket costs for members. Researchers at Harvard University and Mass General Brigham examined a sample of 17,351 privately insured adults, 8,204 of which lived in states that gained protections against surprise billing thanks to the legislation. The remaining 9,147 lived in states where some kind of program was already in place to protect consumers against these costs. Read Full Article...

HVBA Article Summary

1. Significant Consumer Savings from NSA Protections: The study found that state-level implementation of the No Surprises Act (NSA) resulted in an average annual reduction of $567 in out-of-pocket healthcare costs for individuals. This level of savings surpassed those seen from other major policy efforts, including Medicaid expansion ($152 in savings) and the Medicare Part D reforms under the Inflation Reduction Act ($400 in projected savings), suggesting the NSA has been especially impactful in shielding consumers from unexpected charges.

2. Imbalance in Dispute Outcomes and Provider Profit Models: Although the NSA was designed to standardize payments using the median in-network rate—known as the Qualifying Payment Amount (QPA)—the study found that providers, particularly those affiliated with private equity firms, have won 85% of arbitration disputes since late 2023. These wins often result in payouts nearly three times the QPA, undermining the law’s cost-containment goals and preventing expected decreases in insurance premiums. The findings highlight concerns that the law may be inadvertently enabling a shift in profit strategies from patients to the broader insurance system.

3. Need for Broader Protections and Public Awareness: While the NSA has successfully blocked millions of surprise medical bills—an estimated 10 million in just the first nine months of 2023—the study notes critical gaps remain. Protections currently do not extend to ambulance services, a frequent source of unexpected costs. Furthermore, patients with lower health literacy are less likely to navigate the system effectively when faced with surprise bills. The researchers call for stronger enforcement, increased patient education, and expansion of the law’s scope to better protect vulnerable populations and reduce the overall burden of medical debt.

A Judge Approved BCBS’ $2.8B Settlement. Why Some Providers Are Opting Out

By Marissa Plescia – After more than a decade, a judge has approved a historic $2.8 billion class action settlement involving Blue Cross Blue Shield — but for some providers, this isn’t nearly enough. The settlement was to resolve a lawsuit filed in 2012, in which providers and hospitals claimed that Blue Cross and its affiliated plans underpaid them. Providers alleged that Blue Cross violated antitrust laws by dividing the U.S. into “service areas” and agreeing not to compete in those areas. They also argued that the insurer fixed prices for its services. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Record-Setting Settlement Reached: Blue Cross Blue Shield has agreed to pay a $2.8 billion settlement to resolve allegations of anti-competitive practices in a class action lawsuit involving about 3 million providers. This is the largest healthcare antitrust settlement in U.S. history. In addition to the monetary payout, the settlement includes injunctive relief measures, such as mandated reforms to the BlueCard system, intended to improve transparency, reduce inefficiencies, and enhance provider experience.

2. Widespread Dissatisfaction Among Providers: Despite the historic size of the settlement, a significant number of healthcare providers—more than 6,500—have chosen to opt out. Major health systems such as Providence, CommonSpirit Health, and others argue that the financial compensation is too low, especially for large organizations with extensive underpayment claims. Additionally, many feel that the non-monetary reforms included in the agreement do not go far enough to dismantle the systemic issues that allowed the alleged anti-competitive behavior.

3. Ongoing Legal Challenges and Accountability Demands: Several providers who opted out are pursuing independent legal action against Blue Cross Blue Shield. These health systems are seeking more meaningful financial redress, often claiming damages that far exceed the potential returns from the class settlement. They are also demanding more robust, long-term structural changes and accountability measures to ensure that similar anti-competitive practices are prevented in the future. Their overarching goal is to secure fair compensation and improve competitive conditions for delivering healthcare services.

Senators ask Aflac for information about cyberattack

By Allison Bell – A Republican and a Democrat in the Senate are uniting over worries about cyberattacks on the U.S. health benefits sector. The lawmakers joined to write to Dan Amos, the chairman and chief executive officer of Aflac, to ask him about an attack on Aflac's supplemental insurance systems that was disclosed in June. Aflac said in June that it had learned of a breach June 12 and was still determining the scope of the attack. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Senators sought details about Aflac's breach and timeline: The Senate letter asked Aflac CEO Dan Amos for information about an attack on the company's supplemental insurance systems disclosed in June and requested answers by Sept. 5. The senators specifically asked what information may have been compromised, when Aflac first learned of the attack, and when it notified federal agencies.

2. Bipartisan concern over health benefits sector cybersecurity: The letter was signed by Sen. Bill Cassidy (R-La.) and Sen. Maggie Hassan (D-N.H.), showing cross-party worry about cyberattacks on U.S. health benefits systems. The senators cited recent federal warnings about the risk of attacks by hostile actors, including Iran, against health care entities and flagged potential impacts on access to care, quality of care and national defense.

3. Potential implications for employers and sector policy: The article notes the inquiry could foreshadow more health cybersecurity legislation and continued operational difficulties for employers and benefits professionals using administration systems. Aflac told the public it learned of the breach on June 12 and was still determining the scope in its June disclosure. Representatives for Aflac were not immediately available to comment, according to the article.

Workload Up, Payment Down: The Growing Strain on Independent Practices

By Katie Adams – Physicians in the U.S. are doing more work than ever before — but they’re getting paid less. This month, consulting firm Kaufman Hall released new research on work relative value units, or wRVUs, for the nation’s physicians and advanced practice providers. This metric tracks providers’ productivity by measuring the amount of clinical work performed, such as patient visits, procedures and other billable services, adjusted for complexity and time. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Clinical Productivity Is Rising, But Compensation Isn’t Keeping Pace: While physician productivity, as measured by wRVUs, has increased by 12% for physicians and 11% for advanced practice providers since 2023, reimbursement rates have not kept up. Physician pay per visit has declined by 33% since 2001, creating a growing gap between workload and compensation — especially as more patients are projected to lose insurance under the One Big Beautiful Bill Act.

2. Burnout Crisis Driven by Systemic Understaffing and Backlogs:
   Despite higher clinical demands, support staff numbers have dropped by 13% in the past two years, adding stress to physicians. AI tools haven’t significantly alleviated clinic workload. Delayed care during the pandemic has led to long procedure waitlists, exacerbating burnout. The core issue is not technology or documentation systems, but a systemic mismatch between rising workload and shrinking resources.

3. Reimbursement Policy Failures Threaten Independent Practices:
   Physician reimbursement — particularly from Medicare and Medicare Advantage — has failed to keep up with inflation, with outpatient rates dropping 10% since 2016. This pressures independent practices to cut costs drastically or consolidate into larger systems. Without reform, including boosting Medicare rates and regulating Medicare Advantage denials, many independent practices will shut down or be absorbed into health networks, reducing access and accelerating burnout.

Sycamore Partners closes acquisition of Walgreens, splits into 5 standalone companies

By Heather Landi – Private equity firm Sycamore Partners finalized its acquisition of retail pharmacy giant Walgreens and plans to split the company up into five separate businesses. Walgreens, The Boots Group, Shields Health Solutions, CareCentrix and VillageMD will now operate as separate standalone companies, the company said in a press release issued Thursday. Read Full Article...

HVBA Article Summary

1. Sycamore Acquisition and Leadership Changes
   Sycamore Partners has completed its $10 billion acquisition of Walgreens in partnership with Stefano Pessina and his family, who fully reinvested their shares. Walgreens is now a private company, delisted from Nasdaq. Mike Motz, former CEO of Staples US Retail, has been appointed CEO, replacing Tim Wentworth, who will remain on the board. John Lederer has been named Executive Chairman.

2. Strategic Focus and Turnaround Plan
   As part of its restructuring, Walgreens will prioritize its core pharmacy and retail operations, while Sycamore plans to improve operational performance and customer experience. The company has struggled financially, especially due to losses from its healthcare segment, including VillageMD. Walgreens had previously announced the closure of 1,200 stores as part of cost-cutting measures.

3. Future Value and Healthcare Asset Monetization
   In addition to the $11.45 per share payout, shareholders may receive up to $3.00 more per share based on proceeds from the future sale of VillageMD. Sycamore intends to divest VillageMD and other healthcare assets like Summit Health, CityMD, CareCentrix, and Shields Health Solutions, which have contributed to recent financial losses despite overall revenue growth.

Federal PBM probe grows

By Paige Twenter – The House Committee on Oversight and Government Reform said Aug. 28 it is widening its investigation into pharmacy benefit managers, particularly Optum Rx and the Cigna Group, regarding their foreign-based group purchasing organizations. Read Full Article...

HVBA Article Summary

1. Foreign-Based GPOs Raise Oversight Concerns: Lawmakers on the House Committee on Oversight and Government Reform have raised concerns that Group Purchasing Organizations (GPOs) based outside the U.S.—including Ascent Health in Switzerland (affiliated with Cigna’s Evernorth) and Emisar Pharma Services in Ireland (affiliated with UnitedHealth’s Optum Rx)—may be structured to retain more revenue and bypass U.S. laws and regulations designed to ensure transparency and accountability in healthcare contracting and pricing.

2. Congressional Investigation Targets Anticompetitive Practices: A formal investigation launched by the committee in March 2023 is examining potential anticompetitive practices within the pharmaceutical and healthcare benefit management industries. The focus is on how the structure and operations of foreign-based GPOs may contribute to reduced competition and increased costs within the U.S. healthcare system.

3. Accusations of False Testimony from Major Insurers: Committee Chairman Rep. James Comer has publicly accused executives from major healthcare companies—CVS Health, Cigna Group, and UnitedHealth Group—of providing false or misleading testimony during congressional hearings in 2024. In response, the committee has requested internal documents and communications related to the formation and management of the GPOs to further assess the accuracy of their statements and the legality of their business practices.

US FDA approves Teva Pharmaceuticals' generic obesity drug

By Reuters – The U.S. Food and Drug Administration has approved Teva Pharmaceuticals' (TEVA.TA), cheaper generic version of Novo Nordisk's (NOVOb.CO), older weight-loss drug, Saxenda, the Israel-based company said on Thursday. Read Full Article...

HVBA Article Summary

1. Saxenda’s Classification and Function: Saxenda, chemically known as liraglutide, is a first-generation GLP-1 (glucagon-like peptide-1) drug. It works by reducing appetite and aiding in blood sugar control, which can contribute to weight loss. However, its effectiveness in promoting weight loss is generally lower compared to newer GLP-1 drugs like Novo Nordisk’s Wegovy, which have shown greater average weight reduction.

2. FDA Approval of Generic Saxenda: The U.S. Food and Drug Administration (FDA) has officially approved a generic version of Saxenda developed by Teva Pharmaceuticals. This marks the first time a generic GLP-1 medication has been approved specifically for weight loss treatment in the United States, potentially increasing accessibility and affordability for patients.

3. Approved Uses and Target Groups: Saxenda is approved for use in two key groups: obese adults who also have weight-related medical issues (such as type 2 diabetes or high blood pressure), and adolescents between the ages of 12 and 17 who have obesity and weigh more than 60 kilograms. This broadens the drug’s reach across both adult and pediatric populations dealing with obesity.