Daily Industry Report - April 2

Your summary of the Voluntary and Healthcare Industry’s most relevant and breaking news; brought to you by the Health & Voluntary Benefits Association®

Jake Velie, CPT
Vice Chairman, President & COO
Health & Voluntary Benefits Association® (HVBA)
Daily Industry Report (DIR)

Robert S. Shestack, CCSS, CVBS, CFF
Chairman & CEO
Health & Voluntary Benefits Association® (HVBA)
Daily Industry Report (DIR)

Federal Legislation And State Policy Efforts Promote Access To And Use of Discounted Cash Prices

By Jonathan Wolfson, Josh Archambault, Christopher M. Whaley, Cynthia Fisher, and Ge Bai - Since January 1, 2021, the Department of Health and Human Services has required U.S. hospitals to disclose their charges, negotiated prices, and discounted cash prices for all services in machine-readable files. Read Full Article…

VBA Article Summary

  1. Federal Legislative Efforts and Distinctions Between Bills: The article outlines significant legislative movements aimed at enhancing price transparency in healthcare, focusing on the introduction of two bipartisan bills: H.R.5378 by the U.S. House of Representatives and S.3548 by the U.S. Senate. The Senate bill is highlighted for its advantageous provisions over the House bill, particularly in mandating that healthcare providers accept discounted cash prices as full payment from all patients, regardless of insurance status, and in requiring the disclosure of the lowest accepted cash price. These measures aim to foster price competition and improve affordability by directly benefiting both patients and providers.

  2. The Competitiveness of Discounted Cash Prices: Empirical evidence supports the competitiveness of discounted cash prices compared to negotiated insurance rates. Studies have shown that, in many cases, hospitals offer lower prices for cash payments than for insured services. This pricing strategy benefits uninsured patients or those opting not to use insurance due to lower administrative costs and faster payment processes for providers. Additionally, the article notes that competitive cash prices extend beyond hospital services to generic prescription drugs, where cash payments can often lead to lower out-of-pocket expenses for patients.

  3. State Policy Developments and Incentives for Cash Price Utilization: State-level legislative actions have been instrumental in removing barriers that discourage the use of discounted cash prices. Laws enabling "deductible credit" allow payments made at cash price to count towards a patient's deductible, encouraging the use of lower-cost options without penalizing patients' insurance benefits. Moreover, some states have implemented incentive programs that reward patients who opt for more affordable care or prescription drugs. These policies represent a growing recognition of the need to facilitate access to cost-effective healthcare options and the potential of cash prices to contribute to overall healthcare affordability.

HVBA Poll Question - Please share your insights

What is your opinion on RWJBarnabas' decision to drop coverage for GPL-1 medications for weight loss among employees, as reported in the article referenced below?*

Login or Subscribe to participate in polls.

Our last poll results are in!


of Daily Industry Report readers who responded to our last polling question believe PBM practices like spread pricing and increasing hidden fees” is the primary factor contributing to the average 20% increase in pharmacy costs as a percentage of total medical spending for businesses. 

25.13% of respondents believe the primary factor for the increase in pharmacy costs is due to “higher utilization of specialty medications and a lack of resources for discounts on specialty medication,” 23.74% believe it’s due to “increased utilization of prescription drugs,” while 23.49% responded that “rising medication prices” is the main factor. 

Have a poll question you’d like to suggest? Let us know!

Chatbot Beat Doctors on Clinical Reasoning

By Michael DePeau-Wilson - When evaluating simulated clinical cases, Open AI's GPT-4 chatbot outperformed physicians in clinical reasoning, a cross-sectional study showed. Read Full Article…

VBA Article Summary

  1. Comparative Performance in Clinical Reasoning: A study conducted by Adam Rodman, MD, and colleagues at Beth Israel Deaconess Medical Center revealed that GPT-4 outperformed both attending physicians and internal medicine residents in assessing clinical reasoning, scoring higher in the R-IDEA (an assessment of clinical reasoning) scores. GPT-4's median score was 10, compared to 9 for attending physicians and 8 for residents. Logistic regression analysis further supported GPT-4's superior performance, with the highest estimated probability of achieving high R-IDEA scores.

  2. Potential Impact on Clinical Decision-Making: Rodman emphasized the significance of large language models like GPT-4 in improving clinical decision-making, highlighting their ability to overcome cognitive biases that humans may have. This advantage, he noted, could lead to more robust differential diagnoses. However, he also cautioned that physicians using GPT-4 should be aware of its limitations and possess substantial domain knowledge to effectively interpret its guidance.

  3. Study Limitations and Future Directions: The research, which involved attending physicians and residents from two academic medical centers using virtual patients to assess clinical reasoning across 20 clinical cases, pointed out limitations due to the simulation-based nature of the cases and the use of a "zero-shot approach" for the chatbot, suggesting potential for improved performance with iterative training. The study's findings argue for further research into the clinical reasoning capabilities of LLM-physician interactions, suggesting that LLMs are more likely to augment rather than replace human reasoning in clinical settings.

AI Disruption is Coming. Are Healthcare Professionals Ready?

By Peter Zhang and Karen Ka Yan Ng - As the artificial intelligence (AI) market grows to over $400 billion by 2027, the demand for professionals with expertise in machine learning is increasing as AI technology rapidly evolves. Within the healthcare sector, a deep knowledge of the clinical sciences and healthcare skills will no longer be enough. Read Full Article…

VBA Article Summary

  1. Develop Ambidextrous Skills in Ongoing Study and Research: To foster innovation in healthcare, it is crucial to integrate Artificial Intelligence (AI) into the sector. Healthcare professionals are increasingly focusing on AI during their studies and research, driven by the industry's shift towards valuing ambidextrous skills—expertise in both machine learning and health science. For instance, LEO Pharma has implemented AI tools to enhance medical affairs, demonstrating the tangible benefits of AI in reducing workloads and enabling more significant engagements with healthcare professionals (HCPs). This shift underscores the importance of embracing AI to avoid obsolescence and unlock its vast potential in healthcare.

  2. Empower Ambidextrous Professionals to Lead Interdisciplinary Healthcare Teams: The creation of interdisciplinary teams led by professionals skilled in both AI and healthcare is essential for bridging gaps in knowledge and communication, thereby driving efficiencies. The mismatch between the expectations of HCPs lacking technical expertise and the realities of AI's capabilities, along with machine learning experts' limited understanding of healthcare challenges, highlights the need for ambidextrous leaders. These leaders are better equipped to navigate the complexities of AI applications in healthcare and spearhead innovative initiatives.

  3. Find and Cultivate Ambidextrous Talent in Corporate and Academic Environments: Addressing the challenge of developing ambidextrous expertise requires collaboration between the private sector and academic institutions. Initiatives such as public-private partnerships, internships, and fellowships are crucial for enabling HCPs to acquire AI skills. Academic institutions, recognizing the potential of AI in healthcare, are investing in specialized programs, such as the Temerty Centre for AI Research and Education in Medicine at the University of Toronto. Ambidextrous leaders like Dr. Devin Singh, Dr. Jeff Chang, and Dr. Eunice Wu exemplify the innovation possible when professionals are well-versed in both healthcare and AI. Their work in developing AI solutions for healthcare challenges illustrates the critical role ambidextrous professionals will play in driving future advancements in the field.

Biden Administration Cracks Down on 'Junk' Health Insurance Plans

By Joyce Frieden - Health insurance companies selling short-term limited duration insurance (STLDI) will have to spell out what is not covered by their policies under a final rule released Thursday opens in a new tab or window by the Biden administration. Read Full Article…

VBA Article Summary

  1. Introduction of Clear Disclaimers and Coverage Limitations: The new rule mandates insurance companies to provide clear disclaimers detailing what their plans do not cover and guiding consumers on how to find comprehensive insurance. This initiative aims to ensure fairness and transparency, enabling consumers to make informed decisions about their insurance purchases. Additionally, the rule restricts the duration of short-term coverage primarily to 3 months, with certain exceptions allowing for up to 4 months, and is applicable only to new customers.

  2. Addressing the Issue of "Junk Insurance" Plans: The rule targets Short-Term, Limited-Duration Insurance (STLDI) policies that lack comprehensive coverage and do not adhere to critical Affordable Care Act protections, such as covering preexisting conditions. These policies, previously exploited due to loopholes, often misled consumers into believing they were purchasing full health insurance, only to discover inadequate coverage during medical needs. The administration's crackdown on these plans aims to eliminate deceptive practices and protect consumers from unexpected financial burdens.

  3. Impact and Contrast with Previous Proposals: Despite uncertain data on the exact number of individuals affected by the rule, it's suggested that the rule could impact between 1.5 to 1.9 million people currently enrolled in STLDI plans. This move starkly contrasts with proposals from the Republican Study Committee, which aimed to promote such "scammy" health products. In conjunction with another rule aimed at streamlining Medicaid enrollment, these measures are poised to significantly improve healthcare access and security for millions of American families, with both rules set to take effect 60 days after publication.

Round Up: Cost Containment, Denials & Cybersecurity

By Jasmyne Ray - As we wrap up the first quarter of 2024, cost containment, denials management, and cybersecurity stand out as key issues revenue cycle leaders should be mindful of going into the remainder of the year. Read Full Article…

VBA Article Summary

  1. Cost Containment Efforts: Health systems are actively seeking ways to contain or reduce costs due to financial pressures. OSF HealthCare, for example, has managed to stabilize financially after experiencing a -3% operating margin in 2022 by increasing patient volumes, reducing agency costs, negotiating managed care contracts, and excelling in value-based contracts. The organization also employs various vendors to handle specialized billing requirements, such as workers' compensation, third-party liability billing, and coordination of benefits collection, which helps in maintaining financial stability.

  2. Strategic Denials Management: Handling denials from payers is a critical aspect of maintaining efficient revenue cycle operations. Organizations like One Grady, Grady Health’s billing subsidiary, use automation to streamline processes and improve efficiency, with a focus on being intentional and strategic in managing denials. This includes constant communication with payers and leveraging staff expertise, such as medical coders, to effectively address and appeal denials.

  3. Cybersecurity Concerns Heightened: The Change Healthcare cyberattack highlighted the growing threat of cybersecurity breaches and their significant impact on revenue cycle operations. This incident caused substantial revenue losses for affected providers and emphasized the need for enhanced IT and cybersecurity measures. Health systems are now more focused on ensuring business continuity plans are in place to mitigate disruptions, stressing the importance of specialized cybersecurity expertise within the healthcare sector to protect patient information and financial operations.

How US primary care compares to other wealthy nations

By Kelly Gooch  - Among 10 high-income countries, the U.S. trails its peers in access to and continuity of primary care, according to a study released March 28 by the Commonwealth Fund. Read Full Article…

VBA Article Summary

  1. Access to Regular Care: Varied Rates Across Nations: The study revealed that a high percentage of respondents in all 10 countries, including the U.S., have a regular physician or place for care, though the U.S., Sweden, and Canada showed slightly lower rates. Specifically, 87% in the U.S., 88% in Sweden, and 86% in Canada.

  2. Longevity of Patient-Physician Relationships: U.S. and Australia Lag Behind: In terms of long-term relationships with primary care physicians, the U.S. and Australia were notable for having only about 40% of adults reporting a tenure of five years or more with their primary care physician, which is significantly lower compared to other countries in the study.

  3. Disparities in Care Practices: U.S. Primary Care Shows Distinct Gaps: The U.S. showed distinct disparities in primary care practices compared to other nations, including less frequent home visits by physicians, lower rates of screening for social needs like housing and food insecurity, and less common sharing of patient care or medication changes information from specialists or hospitals.

The business case for enhancing your clients’ financial literacy

By Ayo Mseka - An increasing number of agents and advisors are focusing their attention on enhancing their clients’ financial literacy. As many know, clients' financial literacy has numerous benefits for both advisors and their clients. Read Full Article…

VBA Article Summary

  1. Enhancing Financial Literacy Improves Client Outcomes and Empowers Financial Independence: Brian Haney highlights the pivotal role of financial literacy in enabling clients to manage their finances more effectively, increasing their confidence, and promoting long-term financial planning. This empowerment leads to improved money management skills, better risk management, and ultimately, financial independence, as clients are better equipped to navigate life's financial challenges without relying on others.

  2. Mutual Benefits for Clients and Advisors through Financial Education: The process of educating clients about financial literacy yields significant benefits for both clients and advisors. For clients, it translates into a more in-depth understanding of financial planning and a stronger relationship with their advisors. For advisors, it fosters trust, loyalty, and client satisfaction, while also distinguishing them from competitors by emphasizing their commitment to the client's overall financial success.

  3. Foundational Importance of Risk Management in Financial Literacy: Echoing Haney's sentiments, MDRT member David Appel emphasizes the foundational role of risk management in financial literacy. Educating clients early about the importance of planning for unforeseen events enables them to build a secure financial base, which supports more aggressive investment in youth and conservative strategies in later years, leveraging the benefits of compounding and dollar-cost averaging.

Survey of Oncologists Finds Agreement, Concerns Over AI Use

By David Raths - A recent survey of more than 200 oncologists by researchers at Dana-Farber Cancer Institute found broad agreement on how artificial intelligence can be responsibly integrated into some aspects of patient care. Respondents also expressed concern about medico-legal issues as well as how to protect patients from hidden biases of AI. Read Full Article…

VBA Article Summary

  1. Oncologists' Views on AI Knowledge and Patient Consent: The majority of oncologists believe they should be able to explain how AI models work in cancer care, with 85% stating this necessity, yet only 23% think patients need the same level of understanding. Consent from patients for using AI in treatment decisions is deemed necessary by over 81% of respondents. When AI suggests a treatment differing from their initial plan, 37% of oncologists would present both options to the patient.

  2. Attributing Responsibility for AI-Induced Medical or Legal Issues: Responsibility for medical or legal issues arising from AI use in cancer treatment is primarily attributed to AI developers by 91% of the surveyed oncologists, significantly more than those who believe responsibility should also lie with physicians (47%) or hospitals (43%). Additionally, while 76% assert that oncologists should shield patients from biased AI tools, only 28% feel confident in their ability to identify such bias.

  3. Bridging AI Development and Ethical Application in Oncology: The study, led by Andrew Hantel, M.D., and Gregory Abel, M.D., M.P.H., from Dana-Farber Cancer Institute, aims to bridge the gap between AI development and its ethical application in oncology. It highlights the necessity of involving oncologists in discussions about AI's ethical implications, especially as AI's role expands from diagnosis to potentially making treatment recommendations. The findings underscore the urgency in addressing medico-legal issues surrounding AI in healthcare, suggesting a need for clear guidelines on responsibility and accountability in AI-driven treatments.

Common Household Chemicals Tied to Brain Cell Damage

By Megan Brooks - Two classes of chemicals present in common household products may impair the development of oligodendrocytes, the myelinating cells of the central nervous system (CNS), which are critical to brain development and function. However, the researchers as well as outside experts agree more research is needed before any firm conclusions can be drawn. Read Full Article…

VBA Article Summary

  1. Surprising Effects on Brain Cells: A study led by Paul Tesar, PhD, at Case Western Reserve University revealed that quaternary ammonium compounds, widely used in disinfectants, and organophosphate flame retardants, present in many household items, exhibit unexpected detrimental effects on oligodendrocytes, non-nerve cells in the brain involved in forming the insulation around nerve cell axons. The significance of these findings is underscored by increased exposure to these chemicals during the pandemic and highlights the need for reevaluating their usage considering their potential impact on brain health.

  2. Research Findings and Implications: The comprehensive study analyzed the effects of 1823 chemicals on the development of mouse oligodendrocytes in cell cultures, identifying 292 chemicals that cause oligodendrocyte death and 47 that inhibit their generation. Specifically, quaternary ammonium compounds were found to be toxic to these cells, and organophosphate flame retardants halted their maturation. Further epidemiological analysis indicated a link between high levels of a specific flame retardant metabolite (BDCIPP) in children's urine and increased risks of motor dysfunction and the need for special education, suggesting these chemicals could be harmful to human health.

  3. Need for Further Research: Despite these alarming findings, experts, including Shaheen Lakhan, MD, and Sarah Evans, PhD, caution against immediate concern, emphasizing the need for more rigorous studies to confirm these associations in humans and to understand the mechanisms at play. The study presents a critical foundation for investigating how exposure to these chemicals might contribute to neurodevelopmental disorders and conditions like multiple sclerosis, but calls for careful consideration of their use and safe exposure levels in the meantime, pending further research to elucidate the full scope of their impact on health.

Could Regular Exercise Cure Your Insomnia? New Research Says Yes

By Dennis Thompson and Carole Tanzer Miller - Folks who consistently work out two to three times a week are less likely to suffer from insomnia, a new study says. Read Full Article…

VBA Article Summary

  1. Regular Exercise Enhances Sleep Quality: A comprehensive study published in BMJ Open demonstrates that individuals who engage in at least one hour of physical activity each week, distributed over two or three sessions, experience significant improvements in their sleep. They report fewer instances of insomnia and are more likely to achieve the recommended 6 to 9 hours of sleep per night. This research underscores the link between consistent exercise and better sleep outcomes, including a decreased likelihood of experiencing insomnia symptoms.

  2. Quantifiable Benefits Against Insomnia: The study's findings reveal that people maintaining a routine of regular exercise each week are substantially less likely to struggle with falling asleep, with a 42% reduction in difficulties. Additionally, the likelihood of suffering from any insomnia symptoms drops by 22%, and the chances of experiencing multiple symptoms of insomnia decrease by 40%. This data suggests a strong protective effect of exercise against the common issues plaguing good sleep quality.

  3. Long-term Exercise Commitment Promotes Optimal Sleep Duration: The research further indicates that a persistent exercise regimen not only mitigates sleep problems but also aligns sleep duration within the recommended range. Participants who consistently exercised were 55% more likely to achieve 6 to 9 hours of sleep, with a reduced tendency towards both under-sleeping (by 29%) and oversleeping (by 52%). Remarkably, those who adopted an active lifestyle during the study were 21% more likely to transition to normal sleep patterns compared to their inactive counterparts, highlighting the potential of physical activity to foster healthier sleep habits and overall lifestyle.