Daily Industry Report - April 22

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)

“Senator, Saying It Doesn't Make It True”

By Wendell Potter - The health insurance industry maintains a list of reliable go-to members of Congress to call on when profit margins are in danger of being squeezed by a new bill or some government action. As I wrote a few days ago, the insurance lobby relied on the late Sen. Joe Lieberman (I-Connecticut) to kill the public option in 2010 by a one-vote margin. Read Full Article…

VBA Article Summary

  1. Misleading Industry Tactics: The insurance industry's strategy to sway public opinion and political decisions through misinformation was exemplified by Senator John Kennedy's questioning during a Senate hearing. He echoed industry talking points, pushing false claims about Medicare Advantage payments being cut, despite evidence to the contrary.

  2. Manipulation of Data: Kennedy cited a figure suggesting that Medicare Advantage saves seniors an average of $2,400 annually, without disclosing its origin from biased research commissioned by industry groups. This tactic mirrors past instances where flawed research was used to promote policies benefiting insurers, such as the rise of high-deductible health plans.

  3. Political Influence vs. Public Interest: The exchange between Kennedy and Health and Human Services Secretary Xavier Becerra highlights the clash between political rhetoric aimed at protecting insurer profits and efforts to ensure affordable healthcare for seniors. Despite evidence refuting Kennedy's claims, the narrative of cutting Medicare Advantage payments persists, obscuring the reality of taxpayer-funded overpayments to insurers.

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Major health insurance companies are nearing too big to fail status

By Caitlin Owens - Health insurance companies have swelled in both size and scope over the last decade, with the revenues of six for-profit parent companies making up nearly 30% of total U.S. health spending last year — compared with less than 10% in 2011. Read Full Article…

VBA Article Summary

  1. Transformation of Health Insurance Companies: Over the past decade, health insurance companies have evolved significantly, expanding beyond traditional coverage provision to include ownership of various components within the healthcare system. This transformation raises questions about the nature of competition, costs, and quality of care delivery.

  2. Efficiency vs. Reality: While there's an argument that large, diverse health insurance companies can deliver care more efficiently with lower costs and higher quality, evidence supporting this claim remains weak. Despite owning various segments of the healthcare system, these companies are yet to demonstrate substantial improvements in outcomes.

  3. Implications of Market Dominance: The increasing consolidation and size of health insurance companies, coupled with their expansion into government-regulated markets, raise concerns about market competitiveness and the ability of smaller players to survive. This trend also prompts discussions about the potential risks associated with entities that may be "too big to fail" in the healthcare landscape.

HVBA Poll Question - Please share your insights

When it comes to receiving compensation on insurance programs, which payment structure do you prefer?

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Our last poll results are in!


of Daily Industry Report readers who responded to our last polling question “strongly disagree” with “RWJBarnabas’ decision to drop coverage of medications for weight loss among employees, as reported in the article referenced below*.”

14.06% of respondents “disagree,” 11.68% strongly agree,” 10.19% agree” while 10.11% are “neutral.” 

*Article Reference: States clamping down on coverage of weight-loss drugs

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Providers, drugmakers at odds over new 340B dispute resolution process

By Rebecca Pifer - The 340B Drug Pricing Program was created more than three decades ago to support hospitals caring for a disproportionate number of low-income populations, by requiring drugmakers to give those providers discounts on outpatient drugs. Those discounts can be steep — generally 20% to 50% off the list price of a drug. Read Full Article…

VBA Article Summary

  1. Changes in 340B Dispute Resolution: The Biden administration has finalized a rule aimed at reforming the dispute resolution process within the 340B drug discount program. Effective mid-June, the rule seeks to enhance accessibility and efficiency, requiring parties to attempt resolving disputes in good faith before resorting to arbitration. Provider groups laud the rule for streamlining the arbitration process, while pharmaceutical companies criticize it for allegedly favoring hospitals.

  2. Industry Divide Over 340B Program: The ongoing conflict between pharmaceutical companies and safety-net hospitals over the 340B program intensifies as disputes escalate regarding discounts and drug pricing. The program, vital for cash-strapped hospitals, faces opposition from drugmakers concerned about its impact on their profits. The disagreement extends to the administrative dispute resolution process, designed to address issues such as drug diversion and overcharging.

  3. Evolution of Dispute Resolution: Initially introduced in a 2020 final rule, the 340B dispute resolution process faced legal challenges from drug manufacturers, leading to revisions by the HRSA. The updated process aims to be more flexible, removing barriers like the minimum dispute threshold, to facilitate access for all parties. While hospitals welcome the changes as a means to ensure drug company accountability, pharmaceutical companies remain critical, citing concerns over program integrity and fiscal responsibility.

Elevance Health Reports $2.2 Billion Profit Despite Drop In Medicaid Enrollment

By Bruce Japsen - Elevance Health reported a first quarter profit of $2.2 billion as strong growth in sales of commercial health insurance and healthcare services offset a big decrease in Medicaid enrollment. Read Full Article…

VBA Article Summary

  1. Strong Financial Performance: Elevance, a prominent health insurance provider, demonstrated robust financial performance in the first quarter of 2024. Net income surged by 12.2% to $2.2 billion compared to the previous year, while total revenue increased by 1% to $42.6 billion. This growth was primarily attributed to the success of other health benefits businesses and the exceptional performance of Elevance’s Carelon health services division.

  2. Impact of Policy Changes and Market Dynamics: The end of certain COVID-19 pandemic-era coverage provisions, particularly affecting Medicaid enrollees, significantly impacted Elevance's membership numbers. The company experienced a decline in Medicaid enrollment by 21.5% to 9.3 million in the first quarter compared to the previous year. This decrease was attributed to Medicaid redeterminations and expected adjustments in the company's footprint.

  3. Strategic Initiatives and Future Outlook: Despite challenges in Medicaid enrollment, Elevance remains optimistic about its future prospects. The company's forecast predicts increased profits, with diluted earnings per share expected to reach $34.05 and adjusted net income projected to be $37.20 per share. Elevance's CEO, Gail K. Boudreaux, emphasized the importance of disciplined execution of strategic initiatives amid dynamic market conditions. Additionally, the company's recent deal with private equity firm Clayton, Dubilier & Rice underscores its commitment to advancing primary care delivery, signaling further growth opportunities.

UnitedHealth unit Change faces issue processing some medical claims

By Reuters - UnitedHealth Group (UNH.N), opens new tab said on Thursday it had resolved an issue that had hampered processing of batches of medical claims for some customers of its technology unit, Change Healthcare. Read Full Article…

VBA Article Summary

  1. Operability Fix and Monitoring: The operator Optum has successfully implemented a fix to address an issue and is actively monitoring the situation to ensure continued operability. This proactive approach underscores their commitment to maintaining service reliability.

  2. Communication and Transparency: Optum, through a spokesperson, communicated to Reuters that the incident may have impacted a small subset of customers, some of whom may have already been informed. The company pledges to provide further updates as soon as they become available, demonstrating a commitment to transparency and keeping customers informed.

  3. Ongoing Cybersecurity Challenges: It remains uncertain whether the recent incident is connected to the widespread hack in February or if it is part of the resolution process following the attack. Despite ongoing efforts to resume operations disrupted by the February cyber attack, Optum anticipates significant financial repercussions, projecting a potential loss of up to $1.6 billion this year. This highlights the persistent challenges posed by cybersecurity threats and the substantial impact they can have on businesses.

Telehealth linked to modest quality, cost increases, study finds

By Emily Olsen - Telehealth use soared during the COVID-19 pandemic, aided by relaxed rules aimed at preserving access to care during the public health emergency. Read Full Article…

VBA Article Summary

  1. Quality Improvements Linked to Increased Telehealth Adoption: A recent study published in Health Affairs highlights that Medicare beneficiaries receiving care from health systems with high telehealth adoption experienced notable enhancements in office visits, care continuity, and medication adherence, coupled with a decrease in emergency department visits, compared to those with low telehealth use.

  2. Balanced Cost Considerations: Despite a 1.6% increase in healthcare spending among patients in high-telemedicine use systems, the study underscores that the rise was largely driven by inpatient admissions and pharmaceutical costs, while outpatient hospital spending decreased. This balanced perspective challenges the notion that telehealth inevitably leads to significant cost escalation.

  3. Support for Continued Regulatory Flexibilities: The study's findings advocate for maintaining regulatory flexibilities for virtual care, especially in light of pending expiration of some pandemic-era telehealth policies. Legislators, backed by bipartisan support, face critical decisions regarding the future of telehealth payment, provider reimbursement rates, and ensuring sustained access to both virtual and in-person care options.

The nation's 15 biggest pharmacies

By Tina Reed - With $159.4 billion, CVS Health accounts for a fourth of the U.S. pharmacy industry, according to 2023 prescription dispensing revenue data compiled by Drug Channels. Read Full Article…

VBA Article Summary

  1. Dominance of Top Three Players: CVS Health Corp., Walgreens Boots Alliance, and Cigna collectively control over half of the prescription dispensing revenue in the United States, with a staggering $316.2 billion in combined earnings. This underscores the significant market concentration within the pharmacy industry, with these three giants holding substantial sway over the market dynamics.

  2. Consolidation Trends and Potential Disruptions: The landscape of the pharmacy sector is subject to ongoing changes, evident in potential mergers and bankruptcy proceedings. Kroger's potential merger with Albertsons and Rite Aid's bankruptcy proceedings could significantly alter the industry's competitive landscape, potentially reshuffling the top players and their revenue rankings.

  3. Market Share Concentration: Despite the presence of numerous pharmacy businesses, a significant portion of the market is concentrated among a handful of key players. The top 15 pharmacies, as identified by their 2023 revenue, collectively command approximately three-fourths of the market share. This concentration highlights the formidable position held by these entities and the challenges smaller players face in competing effectively within the industry.

Sugar Substitutes Satisfy Appetite, Blunt Insulin Response

By Shrabasti Bhattacharya - Biscuits reformulated with the sweeteners and sweetness enhancers (S&SEs) neotame and stevia rebaudioside M (StRebM) yield similar appetite responses as sucrose-sweetened ones but decrease post-meal insulin and glucose levels in adults with overweight or obesity. Read Full Article…

VBA Article Summary

  1. Trial Design and Participants: The study conducted a randomized crossover trial in England and France from 2021 to 2022, involving 53 adults with overweight or obesity. Participants consumed biscuits with either sucrose or reformulated with sweeteners and sweetness enhancers (S&SEs) daily for three 2-week periods, with washout periods in between.

  2. Outcomes and Findings: The primary endpoint was the composite appetite score, with secondary endpoints including food preferences and postprandial glucose and insulin response. Results showed comparable appetite scores between sucrose and S&SE groups, but S&SEs significantly lowered postprandial insulin levels compared to sucrose. However, S&SEs had no effect on satiety levels, and gastrointestinal issues were more frequent in the S&SE groups.

  3. Practical Implications: Despite gastrointestinal symptoms associated with S&SE formulations, replacing sugar with S&SEs did not show detrimental impacts on the studied endpoints. Moreover, acute and repeated consumption of S&SE-reformulated biscuits blunted glucose and insulin responses, potentially benefiting blood glucose control, especially in individuals at risk of type 2 diabetes.

To manage OCD, mental health benefits make a big impact

By Lee Hefner - Unsolicited and intrusive thoughts are never fun, but they are rarely harmful — unless you cannot turn them off. For the millions of Americans living with obsessive compulsive disorder (OCD), a chronic and widely misunderstood mental health condition, these interruptions can derail daily tasks and routines. Read Full Article…

VBA Article Summary

  1. Comprehensive Mental Health Benefits: Samantha Jean's journey with OCD underscores the importance of robust mental health benefits in the workplace. With access to routine medication and therapy through her employee benefits, she can effectively manage her symptoms, even during challenging periods. This highlights the necessity for employers to offer inclusive benefits that encompass no caps on therapy sessions and access to specialized care for conditions like OCD.

  2. Addressing the Gap in Diagnosis and Treatment: Despite the prevalence of OCD, many individuals remain undiagnosed or untreated due to fear, stigma, and lack of access to specialized care. Paul Silva's experience exemplifies the impact of delayed diagnosis and the subsequent struggle with perfectionism. Employers play a vital role in bridging this gap by providing avenues for early diagnosis and treatment, such as increasing coverage for therapy sessions and fostering open communication about mental health in the workplace.

  3. Creating a Supportive Workplace Culture: Both Jean and Silva emphasize the significance of a supportive workplace culture in managing OCD. While Silva appreciates the understanding and flexibility of his close-knit team, Jean values her company's policies such as flexible work arrangements and access to mental health resources. Employers can further contribute to reducing stigma by fostering open dialogue, promoting wellness initiatives, and ensuring employees feel comfortable seeking support without fear of judgment.

How much longer can employers endure rising healthcare costs?

By Deanna Cuadra - Year after year, employers are faced with rising healthcare costs that for many, feel out of their control. But as benefits budgets become tighter, it's past time for employers to enact what little agency they have and try to get to the bottom of what's driving their healthcare spend. Read Full Article…

VBA Article Summary

  1. Escalating Healthcare Costs: U.S. employers anticipate a 7% surge in healthcare expenses this year, surpassing the typical 4-5% annual increase. With economic and political uncertainties looming, companies are reluctant to absorb these escalating costs, potentially leading to increased financial burdens on employees. Despite over half of Americans being insured, medical debt has soared to $220 billion, affecting around 40% of the population.

  2. Impact of Chronic Conditions: Chronic illnesses like cancer, heart disease, and diabetes are major cost drivers in healthcare. Employers recognize the importance of preventive measures and early intervention in managing these conditions to mitigate healthcare expenditures. However, with large employers witnessing significant price hikes in specialized care, investing in effective health plans and benefits becomes imperative to control costs.

  3. Focus on Preventive Care: Both employers and employees acknowledge the significance of preventive care in reducing healthcare expenses and improving overall wellness. Employers are incentivizing preventive care through various initiatives such as vaccination sessions, educational talks, disease screenings, and monetary incentives. Investing in preventative care not only enhances workforce health but also contributes to a more cost-effective healthcare strategy for employers.