Simplicity is a virtue.

From Washington, DC,

• The Senate will remain in session this week for Committee business and floor voting on Capitol Hill while the House is already out on a District work break.

• Of note,
  • Senate Finance Subcommittee on Health Care
  • August 4, 2026, 10:00 AM (EDT) – Senate | 215 Dirksen Senate Office Building, Washington, D.C.
  • Open Hearing: Hearings to examine building a resilient health care future with biotechnology.
  • Meeting Details

• The Congressional Budget Office posted a report in which “CBO provides current information about the budgetary effects of drug provisions in the 2022 Reconciliation Act; the effects of drug price negotiation, inflation rebates, and the Medicare Part D redesign; and ongoing updates to CBO’s models.”

• Last week, the Government Accountability Office posted a report pointing out its priority recommendations to the U.S. Office recommendations that remain open. Here’s the one that relates to the FEHB and PSHB Programs.
  • “Preventing improper payments. The Federal Employees Health Benefits (FEHB) program is the largest employer-sponsored health care program in the country. In fiscal year 2025, the FEHB program provided health insurance benefits to 8.2 million individuals at a cost to the government and enrollees of approximately $70 billion. OPM has overall responsibility for administering the FEHB program and for ensuring only eligible family members receive coverage. However, OPM has not yet implemented a monitoring mechanism to remove ineligible family members from the FEHB program, as we recommended. On July 4, 2025, legislation was enacted that directed OPM to implement this recommendation.4 By doing so, OPM could prevent improper payments, which OPM has estimated to be up to $1 billion annually.”
• With all due respect to GAO, the biggest internal control gap in FEHB and PSHB eligibility is OPM’s failure to implement the HIPAA 820 standard enrollment roster transaction which would allow carriers to reconcile individual premium payments to each enrollee.

• Govexec reports,
  • “The Office of Personnel Management moved Friday to finalize regulations that collectively seize jurisdiction over thousands of employee appeals, as the federal government’s dedicated HR agency moves to centralize power over the federal workforce.
  • Across three final rules slated for publication in the Federal Register Monday, OPM implemented plans to take over adjudication of federal workers’ appeals of reduction-in-force decisions and suitability actions, as well as cases involving employees still serving in a probationary period. A fourth rule overhauls RIF procedures more broadly, primarily by emphasizing recent performance reviews over tenure.
  • “Currently, a federal employee seeking to appeal an adverse personnel action stemming from a RIF, suitability decision or action that happened while they in their first probationary year of service does so by petitioning the Merit Systems Protection Board. Under the quasi-judicial agency’s jurisdiction, the employee’s case is heard by an administrative judge, with final review by the MSPB’s three-member board. Following a final decision by the agency, the employee—or their employing agency—can appeal to the U.S. Court of Appeals for the Federal Circuit.
  • “But under the new process, appeals would primarily be handled by OPM’s Office of Merit System Accountability and Compliance and ultimately reviewable by the OPM director. Employees would no longer be able to appeal final agency decisions in federal courts.
  • “In a blog post Friday [(Substack link)], OPM Director Scott Kupor said the MSPB is too slow to handle its current workload.”
  • “The current MSPB backlog stretches to many months and, in some cases, years,” Kupor wrote. “That is not good for employees who deserve timely resolution of their appeals and it is not good for agencies, which are left in management limbo while cases wind through a slow and costly adjudicatory process. Our proposed internal appeal processes are designed to be faster, more efficient, and, critically, structurally independent, with separate staff handling determinations and appeals.”

From the public health and medical / Rx research front,

• Healio reports,
  • “About 36 million U.S. adults have chronic kidney disease, with increasing prevalence tied to diabetes, according to study data published in The New England Journal of Medicine. 
  • “National trends on the prevalence of CKD are limited by structural challenges, evolving eGFR equations and other constraints, according to Ashish Verma, MBBS,assistant professor of nephrology at Boston University Chobanian and Avedisian School of Medicine. Verma and Sophie E. Claudel, MD, a nephrology fellow at Boston Medical Center, aimed to quantify CKD prevalence using nationally representative data.”
    
• The New York Times relates,
  • “The Best and Worst Habits for Your Liver
    • “Liver disease is on the rise worldwide. Your diet, workout routine and other health conditions can affect your risk.”
• and
  • “What Doctors Want You to Know About Cervical Cancer Screening
    • “The guidelines have changed recently as new testing options have become available. Getting screened doesn’t have to be painful or confusing.”

• Beckers Hospital Review tells us,
  • “Drugmakers have pushed back their resupply estimates for carboplatin, one of four chemotherapy drugs in a monthslong shortage, with some formulations now not expected to return until 2027.
  • “Cisplatin, carboplatin, oxaliplatin and ifosfamide, which form the backbone of treatment for breast, lung, ovarian, testicular, bladder, and head and neck cancers, remain in active shortage, according to updates posted by the American Society of Health-System Pharmacists.
  • “The ASHP and specialty groups are steering clinicians toward conservation strategies and patient-specific alternatives.” 

• Medscape informs us,
  • “Patients’ willingness to continue to take an obesity management medication for weight-loss maintenance may wane if they believe that it is no longer working based on perceptions of diminished appetite control. Indeed, patients’ beliefs about medication effectiveness have been identified as a predictor of discontinuation. In light of these findings, patients could be counseled to expect a partial return of baseline appetite sensations after the first months of treatment, but, despite these changes, they will continue to eat less food. The continued reduction in food intake is required to maintain the new, reduced body weight, with its decreased energy requirements,” the authors of the study wrote.”

Fron the U.S. healthcare business and artificial intelligence front,

• Healio reports,
  • “Executives from the largest U.S. health care payers cited proactive management of high-risk patients, biosimilar use and site-of-care steerage as their top tactics to lower care costs, according to a survey from Spherix Global Insights.
  • “Spherix surveyed 27 decision-makers from nine of the leading managed care organizations and pharmacy benefit managers (PBMs) in the United States: UnitedHealth Group, CVS Health, Cigna, Kaiser Permanente, Elevance Health, Humana, Health Care Service Corporation, Molina Healthcare, and Centene Corporation. The respondents included directors of pharmacy, planning and network strategy, along with vice presidents of pharmacy strategy and chief medical officers.”
  • “The purpose of this study is to get a deep understanding of the top nine payers in the U.S. market today and highlight how each approaches the market differently,” Sybil Mead, vice president of market access at Spherix Global Insights, told Healio. “The mixed quantitative and qualitative methodology is best to get us beyond the publicly available financial and other secondary-sourced information, to the nuance of strategy and outlook directly from the decision-makers’ perspectives.”

• CIO relates,
  • “One of the biggest challenges companies like Aetna face every year is an annual HEDIS review of its records to identify gaps in care. For large national payors, the scale of the challenge is immense. So Aetna has deployed a gen AI-driven document intelligence platform that has reduced the need for manual review by 65%.
  • “We have a large group of amazing trained medical coders who do this every day,” says Nathan Frank, chief digital and technology officer at Aetna. “This is about making it easier for them by speeding up the process. Something that might have taken weeks or months we can now do in days.”

• Beckers Payer Issues tells us,
  • “Members may not think they are talking to AI when they call their health plan, but the person assisting them might be.
  • “Some insurers have been leaning into member-facing AI capabilities. One of UnitedHealth Group’s 1,000 AI use cases has been using chatbots to handle customer calls, with an AI chatbot initially responding to more than 65 million calls in 2024.
  • “However, there has been a growing trend of AI quietly working behind the scenes on customer service calls, too. These tools aim to boost the member experience by increasing efficiency and accuracy.
  • “Stellarus is a healthcare technology company that spawned from a Blue Shield of California restructuring. Along with its tie to Blue Shield of California, Hawaii Medical Service Association and Blue Cross and Blue Shield of Kansas signed on as Stellarus co-founders, signaling Stellarus’ deep footprint with BCBS plans.
  • “The company just launched its AI-powered Customer Service Representative Chat for health plan staff. CSR Chat is the company’s first product in its Compass suite, an AI-driven engagement platform for health plans.
  • “CSR Chat helps put the right information in front of representatives at the right moment, enabling more consistent service, faster resolutions and better experiences for the people they support,” Vanessa Colella, PhD, president and CEO of Stellarus, said in a July 30 news release.”

• Beckers Physician Leadership informs us,
  • “Physicians on RVU-based compensation plans often have no way of knowing whether the rate they are being paid is fair, and according to one gastroenterologist, that is often by design.
  • “The structural disconnect of wRVUs is well documented. Provider productivity, measured by wRVUs per FTE, has increased 7% since 2023, while provider compensation rose 6% and reimbursement declined 1%, as measured by net patient revenue per provider wRVU, according to Kaufman Hall’s “Physician Flash Report.” 
  • “Overall, wRVUs grew just 1.5% in 2024, down from 5.2% in 2023 and 18.3% in 2022, with the latter driven largely by evaluation and management coding changes, according to the AMGA 2025 Medical Group Compensation and Productivity Survey. Compensation, meanwhile, grew 4.9%. According to the report, about half of that compensation growth is being funded by physicians doing more work, not by gains in reimbursement.
  • “Rajiv Sharma, MD, a gastroenterologist and president of Phoenix-based Mirage Health, told Becker’s the per-RVU rate offered to physicians for identical work can vary drastically from one contract to the next.
  • “I’ve seen RVU rates range from $36 to $95 per RVU,” Dr. Sharma said. “It’s more fluctuation than anywhere else.”
  • “That spread is not accidental, he said.”