Daily Industry Report - April 24

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)

DOL Releases Final Fiduciary Rule

By Melanie Waddell - The Labor Department said Tuesday that it has finalized its new fiduciary rule — the Retirement Security Rule — “to protect the millions of workers who are saving for retirement diligently and rely on advice from trusted professionals on how to invest their savings.” Read Full Article…

VBA Article Summary

  1. Clarification of Fiduciary Responsibility: The final rule redefines the parameters of an investment advice fiduciary under the Employee Retirement Income Security Act of 1975 and the Internal Revenue Code, effectively expanding the scope of responsibility for financial services providers. This clarification ensures that compensated investment advice provided to retirement plan participants, individual retirement account owners, and plan officials aligns with fiduciary standards, promoting transparency and accountability.

  2. Addressing Conflicts of Interest: Lisa Gomez, head of DOL’s Employee Benefits Security Administration, emphasized the prevalence of conflicts of interest within the financial services industry, where professionals may not always act in the best interest of retirement investors despite holding themselves out as doing so. The updated rule aims to rectify this issue by requiring investment professionals to adhere to a professional standard of care, prioritize the retirement investor's best interest, and eliminate misstatements and overcharges in their advice.

  3. Enhanced Prohibited Transaction Class Exemptions: Alongside the redefinition of fiduciary responsibility, the Department of Labor has amended related prohibited transaction class exemptions, including PTE 2020-02 on rollovers and 84-24 on annuities. These amendments complement the revised rule by providing clearer guidelines and safeguards for investment advice fiduciaries, reinforcing the commitment to advancing the best interests of retirement investors.

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ERISA Industry Committee launches ad campaign against updates to mental health parity regs

By Paige Minemyer - A major employer group is launching an ad campaign to oppose significant updates made by the Biden administration to mental health parity requirements. Read Full Article… 

VBA Article Summary

  1. Concerns Over Regulatory Changes: The ERISA Industry Committee (ERIC) is launching a new ad campaign to raise awareness about potential negative implications of federal rule changes to the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The White House introduced regulatory updates to mental health parity requirements last summer, including reviews of provider networks and additional restrictions on prior authorization for behavioral health.

  2. Impact on Access and Coverage: ERIC argues that overhauls to mental health parity could worsen access to care or compel employers to reconsider coverage options altogether. Melissa Bartlett, ERIC’s senior vice president of health policy, emphasizes the need for collaboration between government and health care leaders to improve mental health care access. However, ERIC warns that the proposed changes might inadvertently impede progress.

  3. Industry Response and Alternative Solutions: The proposed regulatory changes have also faced criticism from health plans, with concerns raised about their efficacy in improving access to behavioral health care. The American Health Insurance Plans (AHIP) expressed apprehensions about potential compliance burdens without significant improvements in access. ERIC suggests alternative initiatives, such as expanding telehealth services and integrating mental health training for primary care providers, as more effective strategies to enhance access to mental health care.

CMS sets Medicaid payments to home care workers at 80%

By Noah Tong - The Centers for Medicare & Medicaid Services (CMS) is hoping to improve Medicaid enrollees’ access to care through a final rule that better compensates caregiving roles. Read Full Article…

VBA Article Summary

  1. Wage Allocation Mandate: Under the final rule, a minimum of 80% of Medicaid payments for home care services must be allocated towards wages. This initiative, highlighted in a White House news release alongside a contentious nursing home staffing rule, aims to elevate wages in the sector, potentially enhancing retention rates and thereby improving care quality for seniors and individuals with disabilities.

  2. Flexibility for Small Providers and Rural Areas: States are empowered to consider the distinct challenges faced by small home care providers and those in rural areas. This provision acknowledges the diverse landscape of the home care industry and seeks to tailor regulatory measures accordingly, potentially fostering more equitable access to care.

  3. Enhanced Transparency and Accountability: States are mandated to disclose their home care service payments and rate-setting methodologies. Additionally, they must track metrics such as wait times, waiting lists, and quality measures. The establishment of a home care rate-setting advisory group, comprising beneficiaries and workers, aims to ensure ongoing consultation and refinement of payment rates, fostering greater transparency and accountability in the delivery of home care services.

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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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A cheap drug may slow down aging. A study will determine if it works

By Allison Aubrey - A drug taken by millions of people to control diabetes may do more than lower blood sugar. Research suggests metformin has anti-inflammatory effects that could help protect against common age-related diseases including heart disease, cancer, and cognitive decline. Read Full Article…

VBA Article Summary

  1. Research Evidence of Anti-inflammatory Effects: Studies suggest that metformin possesses anti-inflammatory properties, potentially guarding against prevalent age-related ailments such as heart disease, cancer, and cognitive decline.

  2. The TAME Trial: Investigating Metformin's Preventative Potential: Aging biology experts are spearheading the TAME Trial, aimed at determining whether metformin can stave off diseases and extend healthy aging in older adults, emphasizing its potential for enhancing healthspan.

  3. Challenges and Promises of Metformin: While metformin's affordability and safety profile make it an attractive candidate for preventive medicine, funding hurdles for the TAME Trial underscore the need for broader recognition of aging as a treatable condition, potentially revolutionizing how age-related diseases are approached and treated.

Rethinking retirement: Income needs to be the outcome, as America is hitting 'peak 65'

By Alan Goforth - By the end of today, about 11,200 Americans will turn 65, and more than 4.1 million people will reach that milestone each year through 2027. Read Full Article…

VBA Article Summary

  1. Demographic Shift: By the end of this decade, the United States will experience a significant demographic shift, with more people over 65 years old than under 18. This marks a drastic change from the demographic distribution of just a few decades ago, posing challenges for retirement planning and societal support systems.

  2. Financial Challenges: The demise of traditional retirement plans, such as defined-benefit pensions, has shifted the responsibility of managing income during retirement to individuals. Approximately 50% to 60% of retirees are now at risk of not maintaining their standard of living throughout retirement, highlighting the urgency for effective financial planning solutions.

  3. Paradigm Shift in Retirement Planning: With the traditional three-legged stool of retirement security (Social Security, employer contributions, and personal savings) becoming less reliable, there's a need for a paradigm shift. Retirement planning now requires a focus on generating consistent income throughout retirement, necessitating innovative approaches to asset management and financial advice tailored to individual needs.

Most doctors, consumers need transparency to trust generative AI in clinical decisions, survey finds

By Anastasia Gliadkovskaya - Though physicians are quickly growing more comfortable with generative AI, the vast majority expect models to be transparent and trained on credible information, a new survey found. Read Full Article…

VBA Article Summary

  1. Shifting Perception Among Physicians: In a Wolters Kluwer Health survey of 100 physicians, 68% reported changing their views on generative AI over the past year, with 40% expressing readiness to integrate it into their clinical practice in the current year.

  2. Divergent Views Between Clinicians and Consumers: While clinicians demonstrate increasing acceptance of generative AI, a separate survey of 1,000 consumers revealed significant concerns, with 4 in 5 expressing apprehension about its use in diagnosis. Conversely, only 1 in 5 physicians believed patients would share these concerns.

  3. Importance of Guardrails and Transparency: Both physicians and consumers emphasize the necessity of clear guidelines and transparency surrounding the use of generative AI in healthcare. Physicians prioritize data originating from medical experts and transparent sourcing, while consumers demand clarity from clinicians regarding the technology's utilization.

Starter 401(k) plans under SECURE 2.0: Helping small employers fast-track a retirement plan

By Lisa A. Tavares and Carol V. Calhoun - In 2022, almost half of American households had no savings in retirement accounts, according to the Survey of Consumer Finances (SCF). The situation is particularly acute with employees of small employers, which may not offer retirement plans at all. Read Full Article…

VBA Article Summary

  1. Automatic Enrollment and Contribution Limits: In a Starter 401(k) Plan, all eligible employees are automatically enrolled, with deferrals ranging from 3% to 15% of compensation, unless they opt out or choose a different contribution level. However, the contribution limits are capped at the lesser of 15% of compensation or $6,000 ($7,000 for those 50 or older), adjusted annually for inflation.

  2. Employer Eligibility and Flexibility: Unlike previous retirement plans designed for small employers, Starter 401(k) Plans have no size limitations. While small employers are expected to be the primary adopters, they are available to employers of any size. However, certain groups of employers, such as those maintaining other qualified plans or state-mandated retirement plans, may be precluded from adopting Starter 401(k) Plans under specific conditions.

  3. Advantages and Considerations: Starter 401(k) Plans offer simplicity, cost-effectiveness, and exemption from certain regulatory requirements compared to traditional 401(k) plans. However, they come with limitations such as lower employee contribution limits, mandatory coverage for all eligible employees, and challenges in accurately calculating compensation. Additionally, issues may arise in mergers or acquisitions involving companies with different retirement plans, potentially affecting employee benefits and employer costs.

GLP-1s Could Benefit OSA, But Healthy Habits Are Still Key, Experts Say

By Walter Alexander - Will the weight reduction successes seen with use of glucagon-like peptide 1 (GLP-1) agonists translate into improvement in obstructive sleep apnea (OSA)? Will those potential OSA benefits reduce the need for continuous positive airway pressure (CPAP)? Read Full Article…

VBA Article Summary

  1. Potential for OSA Improvement with GLP-1 Agonists: Studies indicate that GLP-1 agonists coupled with lifestyle changes can significantly improve obstructive sleep apnea (OSA) severity. Research demonstrates that interventions combining CPAP therapy with weight loss and lifestyle modifications yield clinically meaningful and sustainable improvements in OSA, suggesting a promising avenue for managing the condition.

  2. Health Equity Concerns and Access to GLP-1s: While GLP-1 agonists show promise in managing obesity and its complications, concerns arise regarding access and affordability. High medication costs may limit universal healthcare funding schemes' ability to provide widespread access, potentially exacerbating healthcare disparities between socioeconomic populations. Thus, ensuring equitable access to these medications while mitigating cost-related barriers is crucial for maximizing their impact.

  3. Emphasizing Lifestyle Changes: Despite the effectiveness of GLP-1 agonists, experts stress the importance of lifestyle modifications in managing obesity and related conditions. Behavioral changes such as adopting healthier dietary habits and increasing physical activity remain essential components of comprehensive treatment strategies. Highlighting the impact of dietary choices, particularly the consumption of ultra-processed foods, underscores the need for promoting healthier eating habits alongside pharmacological interventions to achieve sustainable weight loss and improve overall health outcomes.

AI eye exams are proving their worth — providing quick diagnoses, without a doctor

By Hannah Norman - Christian Espinoza, director of a Southern California drug-treatment provider, recently began employing a powerful new assistant: an artificial intelligence algorithm that can perform eye exams with pictures taken by a retinal camera. It makes quick diagnoses, without a doctor present. Read Full Article…

VBA Article Summary

  1. Revolutionizing Screening Accessibility: The adoption of AI-based systems for diabetic retinopathy screening, exemplified by Tarzana Treatment Centers, heralds a transformative shift in healthcare accessibility. By offering quick and easy screenings requiring minimal training, these systems eliminate the cumbersome traditional process, ensuring immediate results and reducing the need for additional specialist appointments.

  2. Enhanced Patient Engagement and Follow-up: Patients benefit from the convenience and efficiency of AI-enabled screenings, resulting in increased compliance with screening recommendations. The proximity of receiving immediate results prompts higher patient engagement, leading to a threefold increase in follow-up actions compared to conventional methods. This proactive approach facilitates early intervention and specialist referrals, crucial for managing diabetic retinopathy effectively.

  3. Driving Healthcare Innovation and Equity: The integration of AI technology in healthcare not only addresses critical gaps in screening accessibility but also drives innovation and equity. Despite challenges such as regulatory hurdles and technical integration, AI diagnostics for diabetic retinopathy demonstrate tangible benefits for both patients and providers. As the technology evolves and expands to include handheld imagers for field screenings, it holds promise for broader application in addressing various eye diseases, ultimately advancing healthcare equity and accessibility.

Healthcare just one part of Americans' pricing nightmare

By Molly Gamble - Critiques of out-of-pocket spending in healthcare have long centered on the erratic nature of prices, with comparisons resting on sticker stability in other industries — a reference point that may not be as valid today as it once was. Read Full Article…

VBA Article Summary

  1. Evolution of Pricing Models: From the advent of dynamic pricing by airlines in the 1980s to the proliferation of fees and surcharges across industries like travel and events, pricing strategies have undergone a transformative journey. Airlines pioneered the concept of booking early for lower fares, while subsequent decades saw the rise of ancillary fees, resort fees, and marked-up ticket prices, reflecting a shift towards maximizing profits through add-ons and surges.

  2. Rise of Personalized Pricing: The emergence of personalized pricing introduces a new layer of complexity, leveraging user data to set prices based on individual willingness to pay. While this approach offers potential for increased revenue, concerns about fairness and exploitation abound, particularly in critical sectors like healthcare where AI-based pricing could exacerbate disparities in access and affordability.

  3. Championing Pricing Integrity: Amidst a landscape increasingly marred by opaque pricing practices, Mark Cuban's pharmaceutical wholesaler stands out as a beacon of pricing integrity. By adopting a transparent model where each drug is priced at manufacturing cost plus modest fees, Cuban challenges the status quo and emphasizes a commitment to consumer welfare over maximizing profits, setting a compelling example in an era where such principles are increasingly rare.