Daily Industry Report - April 5

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)

Invitation to Health & Voluntary Benefits Association® (HVBA) Benefit Networking Roadshow

By HVBA - The Health & Voluntary Benefits Association® (HVBA) is thrilled to extend a warm invitation to all benefits professionals for the upcoming Benefit Roadshow, an industry networking event, scheduled for Thursday, June 27, 2024. Read Full Article…

VBA Article Summary

  1. Educational Opportunities on Legislative Updates and Healthcare Systems: The HVBA’s Benefits Roadshow is designed to be an engaging and informative event, featuring three Continuing Education (CE) sessions that provide insights into current legislative updates related to the Consolidated Appropriations Act, Employee Retirement Income Security Act, and Long-Term Care, alongside detailed explorations of Medicaid and Medicare.

  2. Networking and Professional Development at the Benefits Roadshow: Beyond the educational sessions, the event facilitates a rich networking environment through the Benefits Roadshow networking reception, offering attendees the chance to build business connections, explore industry prospects, enjoy fine dining with hors d'oeuvres and premium cocktails, and engage in conversations in a setting conducive to professional growth.

  3. A Unified Industry Gathering: Vision and Complimentary Access: Emphasizing the value of community and professional development, Rob Shestack, Chairman & CEO of the HVBA, highlights the roadshow's goal of uniting industry professionals for learning, networking, and collaboration. As a token of gratitude and to encourage widespread participation, HVBA is offering complimentary tickets to this exclusive event, supported generously by sponsors.

Secure your spot today. On us!

The Heritage Foundation's Medicare and Social Security Blueprint

By Trudy Lieberman - If Congress in the next year or two succeeds in transforming Medicare into something that looks like a run-of-the mill Medicare Advantage plan for everyone – not just for those who now have the plans – it will mark the culmination of a 30-year project funded by the Heritage FoundationRead Full Article…

VBA Article Summary

  1. Privatization and Limitation of Benefits: The Heritage Foundation, gaining prominence in the 1970s and 1980s, embarked on a mission to privatize and potentially eliminate major progressive government programs like Medicare, Social Security, and Workers' Compensation. This shift aims to replace universal entitlement programs with privatized options that offer lesser benefits to fewer people, essentially transforming these programs into welfare-like systems where only the neediest could receive benefits.

  2. Impact on Consumers and Legislation: With 30 million people already enrolled in private Medicare Advantage plans, many are attracted by short-term benefits like gym memberships and dental coverage, often without full awareness of the potential restrictions and high costs associated with serious illnesses. Legislation supported by the Heritage Foundation and some Republican members of Congress is being considered to study recommendations for ending Medicare and Social Security as universal programs, which could further limit access to essential services for millions of Americans.

  3. Campaign to Change Public Perception and Policy: The Heritage Foundation has led a 30-year campaign to privatize Medicare and influence media portrayal of such privatization efforts. By issuing reports, influencing media narratives, and advocating for legislation that promotes a premium support system, the Heritage Foundation aims to transform Medicare from a social insurance program into a privatized system more akin to private health insurance, which could undermine the traditional Medicare system and potentially leave millions of seniors vulnerable to the priorities of profit-driven insurance companies.

HVBA Poll Question - Please share your insights

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

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 “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

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

With Steward's struggles on full display, clinicians, lawmakers sound the alarm on private equity's impact on healthcare

By Dave Muoio - Steward Healthcare, UnitedHealth Group’s Optum, HCA Healthcare and a laundry list of private equity investors were in the firing line of a congressional field hearing on “corporate greed” in healthcare held Wednesday. Read Full Article…

VBA Article Summary

  1. Legislative Actions and Transparency Initiatives: Sen. Edward Markey and Sen. Elizabeth Warren utilized a session to underscore proposed legislation aimed at reconciling the divergent goals of profit-seeking investors and the delivery of quality care. Markey introduced a discussion draft called the Health over Wealth Act to enhance ownership transparency within healthcare entities, seeking public input. This initiative reflects growing discontent with the existing for-profit health system's performance, particularly highlighted by the negative financial aftermath linked to the management strategies of Cerberus Capital Management and its impact on healthcare access.

  2. Criticism of For-Profit Health Practices: The session at the Massachusetts State House was a platform for voicing issues related to the for-profit healthcare system, notably critiquing the actions of Cerberus Capital Management and its management of healthcare entities. Witnesses and lawmakers condemned practices such as overleveraging with debt and prioritizing dividends and rapid expansion over reinvesting in the healthcare infrastructure and workforce. The hearing illuminated the broader issue of for-profit health systems, like HCA Healthcare, prioritizing shareholder profits over patient care and the detrimental effects this has on healthcare quality and accessibility.

  3. Call for Oversight and Regulatory Reform: The discussions and testimonies called for a significant overhaul in how healthcare entities are governed and regulated, emphasizing the need for transparency and oversight to prevent the detrimental impacts of profit-driven strategies on healthcare quality and access. Experts and lawmakers advocated for legislative measures such as Warren's Stop Wall Street Looting Act to impose restrictions on payouts and liabilities of investment firms. The session underscored the misalignment of investor interests with healthcare goals and the necessity of reforming governance structures to ensure healthcare systems prioritize patient care over profit.

CMS finalizes ACA network adequacy rule

By Rebecca Pifer - The adequacy of plans’ provider networks is key for members actually being able to access care covered by their health insurance plan. States and the federal government oversee the networks in the ACA marketplaces, but enforcement has been lax, critics and researchers say. Read Full Article…

VBA Article Summary

  1. Harmonizing Healthcare Standards: Biden Administration's New Mandate for State-Run ACA Exchanges: The Biden administration has finalized new network adequacy standards for state-run Affordable Care Act exchanges, effective from 2026, aligning them with federal marketplace standards. This includes minimum time and distance requirements for accessing various medical specialties. Additionally, states now have the option to include dental services as an essential health benefit starting in 2027.

  2. Addressing Network Adequacy: Federal Standards Extended to State Exchanges to Improve Provider Access: The updated rules respond to findings that a significant number of plan issuers on federal exchanges failed to meet existing network adequacy standards in the 2023 plan year. Similar compliance issues have been reported by states, highlighting challenges in ensuring geographic accessibility to healthcare providers. The new standards will be enforced on a county-by-county basis to address these disparities, especially in underserved areas.

  3. Enhancing Enrollment Periods: New Regulations for State Marketplaces to Boost Accessibility: Alongside network adequacy improvements, the regulation introduces changes to the enrollment periods for state marketplaces. This includes aligning states' open enrollment periods with that of the federal exchanges, running from November 1 to January 15, and extending special enrollment periods for low-income families, aiming to enhance accessibility and flexibility for consumers.

Finger on the Pulse: The State of Primary Care in the U.S. and Nine Other Countries

By Alexis Kayser - For many people, primary care is their first point of contact with the health system, and decades of evidence shows it is critical for population health, health equity, and the overall efficiency of health care systems.1 Read Full Article…

VBA Article Summary

  1. Challenges in Accessing High-Quality Primary Care: The importance of primary care as the foundation for positive health outcomes is highlighted, yet health systems worldwide face significant challenges. These include ensuring access to care, maintaining continuity and comprehensiveness of care, and coordinating care effectively. Workforce shortages, physician burnout, and dwindling patient access due to underinvestment and growing administrative burdens are identified as major barriers to providing effective primary care.

  2. Comparative Analysis with High-Income Nations: The article details a study comparing the state of primary care in the United States with that in nine other high-income countries, based on the Commonwealth Fund’s 2022 and 2023 International Health Policy Surveys. Key findings reveal disparities in the accessibility of regular doctors, the rate of home visits by physicians, the screening for social needs, and coordination of care with specialists. The U.S. notably lags behind in several areas, including the percentage of primary care providers making home visits and the adequacy of care coordination.

  3. Recommendations for Strengthening Primary Care: The article concludes with recommendations for policymakers to enhance primary care in the United States, such as increasing investment in primary care, growing the primary care workforce, reforming primary care payment models, facilitating better care coordination, and reducing the administrative burden on primary care physicians. These steps aim to expand access to care, including through telehealth and after-hours appointments, make care more comprehensive by integrating behavioral health and addressing social needs, and improve the overall patient and provider experience within the health system.

ACLI Members Concerned IB 95-1 Changes Will Cause ‘Chilling Effect’ on PRT Market

By Remy Samuels - Department of Labor modifications to Interpretive Bulletin 95-1 could create “negative repercussions” for workers and retirees involved in pension risk transfers if they do not take into account industry concerns, members of the American Council of Life Insurers argued during a roundtable event Thursday that the report. Read Full Article…

VBA Article Summary

  1. Delay and Concerns Over Pension Risk Transfer (PRT) Regulations: Under the SECURE 2.0 Act of 2022, the Department of Labor (DOL) was tasked with reviewing IB 95-1, which sets fiduciary standards for choosing an annuity provider for pension risk transfers. The DOL's delayed recommendations, expected by the end of 2023, have increased industry worries about potential changes that might adversely affect the PRT market. Critics, like Preston Rutledge, a consultant to the American Council of Life Insurers (ACLI), express concern that new guidance might scrutinize the annuitization process negatively, impacting how defined benefit pension plans transfer obligations to insurance companies.

  2. Arguments for Public Rulemaking and Concerns Over ERISA Protections: Rutledge suggests that rather than issuing new guidance, the DOL should engage in a notice and comment rulemaking process, allowing for public input and hearings before finalizing any regulations, given that IB 95-1, as guidance, does not require public notice before finalization. Concerns among critics include the loss of protections under the Employee Retirement Income Security Act (ERISA) and the Pension Benefit Guaranty Corporation when a PRT occurs, and skepticism about the reliability of life insurance companies compared to traditional pension plans. However, Rutledge argues that state-regulated systems offer strong protections.

  3. State Insurance Regulation Defense Amidst Lawsuits: Jillian Froment, ACLI’s EVP and General Counsel, emphasizes the strength of state insurance regulation, focusing on consumer protection and the financial stability of insurers, arguing it's recognized globally for its effectiveness. This comes as lawsuits challenge the safety of retirement assets transferred through PRTs, like the case against AT&T for transferring pension liabilities to an insurance company with significant reinsurance activities in Bermuda. However, ACLI representatives argue that Bermuda's regulatory regime is rigorous and internationally recognized, suggesting a strong framework for cross-border reinsurance transactions.

AMGA Leaders Express Frustration with CMS’s Benchmark Rate Cut for MA Plans

By Mark Hagland - The leaders of physician groups most active in value-based contracting and especially in risk-based contracting with payers, are feeling a range of financial and operational pressures these days. Read Full Article…

VBA Article Summary

  1. Increasing Healthcare Service Utilization and Rising Costs: Healthcare services' utilization is on the rise, leading to increased costs per member per month. At the same time, reimbursement rates from healthcare payers, including Medicare Advantage programs, are not adequately keeping up with these rising costs. This includes both the direct costs of providing healthcare services and the indirect costs associated with care management and coordination. This discrepancy is causing concern among healthcare providers and organizations.

  2. Medicare Advantage Program Challenges: A significant number of Medicare beneficiaries, over half, are now enrolled in Medicare Advantage plans, giving these private health plans considerable leverage in contract negotiations with providers. The American Medical Group Association (AMGA), representing large medical groups' interests, has expressed frustration with the Centers for Medicare & Medicaid Services' (CMS) finalized 2025 benchmark rate for Medicare Advantage plans. They argue that a slight cut in the benchmark payments fails to account for the increased cost of providing care and the rise in service utilization, potentially leading to reduced benefit packages that could adversely affect both patients and providers.

  3. Concerns Over Payment Reductions and Quality Measure Alignment: The AMGA has raised alarms about ongoing payment reductions in Medicare Advantage and traditional Medicare, compounded by the phase-in of changes to the Medicare Advantage risk adjustment model that could result in further payment decreases. Additionally, the AMGA supports CMS' efforts to align quality measures across programs through the Universal Foundations measure set, aiming to simplify reporting processes and reduce provider burden while maintaining relevant and actionable data. This effort reflects AMGA's ongoing commitment to collaborate with CMS to enhance healthcare quality and efficiency, despite facing operational and reimbursement challenges in the current policy environment.

Hospital care costs are out of control. Price caps can help

By Roslyn Murray and Andrew Ryan - Here’s just the tip of the iceberg: $722.50 for a nurse to push a drug into an IV. $21,500 for ten stitchesRead Full Article…

VBA Article Summary

  1. Oregon's Successful Experiment with Hospital Price Caps: In response to soaring healthcare costs, Oregon implemented a legislative price cap on hospital prices for services provided to members of its state employee plan. This cap, set at twice the Medicare rates for hospital payments, led to significant savings of $107.5 million over two years without affecting hospital coverage for state employees or negatively impacting hospital operations, patient access, and patient experiences.

  2. The Importance of Legislative Backing and the "Goldilocks" Balance: Oregon's approach to capping prices showcases the critical role of legislative support in ensuring the success of such measures. By setting the cap at a level that neither discourages hospitals from providing care nor allows them to continue charging exorbitant prices, Oregon found a balance that cut into hospitals' excess profits without compromising access to essential healthcare services.

  3. Implications for National Healthcare Reform and the Potential for Broader Application: Oregon's experiment serves as a blueprint for other states looking to control spiraling healthcare costs without disrupting care. The success of the price cap suggests that similar strategies could be effective elsewhere, especially in light of hospital industry resistance to such measures. More research is needed to understand the broader implications of price caps on healthcare access and quality, but Oregon's experience points to their potential as a tool for ensuring affordable care in monopolistic healthcare markets.

Purina Teams Up with Petzey to Make On-Demand Pet Telehealth More Accessible

By Petzey - The pet experts at Purina are teaming up with Petzey, an on-demand mobile pet telehealth and wellness app, to make access to quality veterinary care more convenient for busy U.S. pet parents. Petzey offers on-demand pet health and wellness guidance through affordable virtual vet consultations and adds to Purina’s growing list of pet expert-created content, tools and technology designed to help pet owners find, feed and care for their dogs and cats. Read Full Article…

VBA Article Summary

  1. Affordable and On-Demand Veterinary Access: Petzey offers an innovative solution for pet owners facing challenges with timely and affordable access to veterinary care. By providing on-demand access to certified veterinary professionals nationwide, Petzey ensures pet parents can obtain expert health and wellness guidance for their pets at a cost-effective rate of $20 per virtual consultation. This service acts as a supplement to traditional in-office veterinary care, offering immediate answers to concerns about a pet’s health.

  2. Partnership with Purina for Enhanced Benefits: In collaboration with Purina, Petzey enhances the value it provides to pet parents, especially to members of the MyPurina program. Members can use their Purina Perks points to get discounts on Petzey telehealth consults, making pet healthcare even more accessible. The partnership also extends to exclusive offers through the MyPurina app, which serves as a comprehensive hub for pet care, offering tailored information, enrichment activities, nutrition advice, and access to a range of tools and technology aimed at improving pet wellness.

  3. Comprehensive Support for Pet Parenting: The MyPurina app, fueled by the partnership between Purina and Petzey among others, is designed to be a one-stop resource for pet parents. It enables the creation of unique pet profiles, provides personalized nutrition information, and suggests at-home enrichment activities to strengthen the bond between pets and their owners. Moreover, it offers exclusive deals and trial opportunities from Purina’s wide range of pet food, litter brands, and Petivity pet technology products, aiming to support pets in living longer, healthier lives.

5 updates on weight loss drugs

By Paige Twenter - Sen. Bernie Sanders wants to schedule a meeting with Novo Nordisk's CEO after researchers said its blockbuster Type 2 diabetes drug, Ozempic, could remain profitable if it was made for less than $5, Bloomberg reported March 28. Read Full Article…

VBA Article Summary

  1. Hospital Operations Impact: GLP-1 medications are significantly impacting hospital operations, especially within transplant and bariatric departments across the U.S. They are facilitating weight loss for donors and diabetic patients to meet surgery eligibility criteria due to strict body mass index cutoffs. However, the increased demand for these drugs is causing a noticeable decrease in bariatric surgeries and referrals, with some regions experiencing up to a 20% decline in operations.

  2. Safety Concerns and Recommendations: Recent research highlighted safety concerns associated with GLP-1s, particularly when taken before surgical procedures. A study from Cedars-Sinai in Los Angeles found a 33% higher risk of aspiration pneumonia in patients undergoing endoscopy who had taken GLP-1s compared to those who hadn't. This follows recommendations from the American Society of Anesthesiologists to skip doses before surgeries due to potential complications.

  3. Issues with Access and Emerging Demand: Despite their effectiveness, a study revealed that only a small fraction (2.3%) of obese patients at an outpatient clinic received prescriptions for weight loss drugs, pointing to significant barriers such as insurance coverage, drug shortages, and stigma. Meanwhile, demand for GLP-1s is rising, with new drugs entering the market and forming partnerships for distribution, like the one between Amazon Pharmacy and Eli Lilly for Zepbound.