Biden administration still has mental parity regs in pipeline

By Allison Bell - The Biden administration has already completed most of the health benefits regulatory projects on its to-do lists, but it's still polishing a major set of behavioral health regulations. Read Full Article…

HVBA Article Summary

1. Regulatory Update and Compliance Challenges: The Centers for Medicare and Medicaid Services (CMS) and the Internal Revenue Service (IRS) are finalizing updates to the regulations implementing the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Consolidated Appropriations Act, 2021. These updates, listed in the semiannual regulatory agendas of both agencies, address key issues such as "non-quantitative treatment limits," which have been a significant point of contention for employers and insurance carriers. Stakeholders have expressed difficulties in meeting the proposed definitions and tests for ensuring comparability in coverage of behavioral health care versus other health services.

2. Inter-Agency Coordination and Delays: Although both CMS and the IRS aimed to finalize the behavioral health regulation updates by July, the U.S. Department of Labor, which has previously been involved in updating these regulations, did not include this project in its latest agenda published on the same day. This absence may indicate a shift in participation or priorities, possibly influenced by the recent Loper Bright Enterprises v. Raimondo Supreme Court decision that challenges the extent of federal agencies' authority in interpreting regulations.

3. Implications of Supreme Court Decisions: The Loper Bright ruling, which overturned the Chevron deference—a precedent that mandated judicial deference to federal agency interpretations of their own regulations—could significantly impact how these updated mental health parity regulations are applied. This decision might lead to stricter scrutiny of federal agencies' actions and could soften the impending regulations, aligning more closely with statutory limits and potentially altering the regulatory landscape for mental health and addiction equity.

The Next Era of Pain Management: The Convergence of Scientific Innovation and Public Policy Incentivization

By Frank D. Lee - Pain management has come a long way in the last 20 years. Some in the industry, myself included, are cautiously optimistic that we’ve stepped into a new era. The old model — “an opioid for almost every kind of pain” — is increasingly recognized as an outdated and risk-laden approach. Read Full Article…

HVBA Article Summary

1. Progress and Challenges in Combatting the Opioid Epidemic: Despite some strides made in fighting the opioid crisis, with 107,543 Americans succumbing to opioid dependence in 2023 alone, the issue remains a national crisis. Post-surgical prescriptions are identified as significant "gateways" to opioid misuse, with research indicating that up to 17% of surgical patients may become persistent opioid users. Additionally, the risk of opioid misuse extends beyond the patients to their families and communities through the diversion of unused prescriptions.

2. Advances in Non-Opioid Pain Management: Over the past decade, the development and FDA approval of non-opioid therapies have offered effective pain management alternatives that reduce the risk of opioid use disorder (OUD). These treatments not only alleviate the fear of relapse for patients in recovery but also aim to decrease long-term societal healthcare costs, which include treatment for OUD and related economic impacts amounting to approximately $1.5 trillion annually.

3. Policy Developments and Future Directions: The Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act, passed in 2022, is set to enhance access to non-opioid options starting January 1, 2025, by mandating Medicare to provide separate reimbursement for these therapies in outpatient surgical settings. This policy, supported by a wide coalition, is a crucial step towards wider adoption of opioid-sparing strategies. However, continued efforts in scientific research, policy advocacy, and education are essential to ensure broader access to these therapies and to further reduce opioid dependency rates.

AG urges R.I. health insurance commissioner to reject proposed premium hikes

By Alexander Castro - Deny, deny, deny: That’s what Rhode Island Attorney General Peter Neronha is asking the state’s health insurance commissioner to do with the premium hikes requested by a half dozen Rhode Island insurance companies for 2025. Read Full Article…

HVBA Article Summary

1. Scope and Critique of Rate Increases: Rhode Island Attorney General Peter Neronha has issued a strong critique against the proposed health insurance rate increases ranging from 2.5% to 22.7% for the 2025 fiscal year. He has called on the state's Health Insurance Commissioner, Cory King, to reject these increases, particularly highlighting the excessive request of 22.7% from UnitedHealthcare for small group market rates. Earlier, Neronha had opposed a similar rate increase proposal from Blue Cross Blue Shield of Rhode Island for being excessively high.

2. Systemic Issues and Recommendations: Neronha has articulated concerns about systemic problems in the U.S. healthcare system, pointing out that despite heavy investments, the health outcomes remain subpar, especially for people of color, and life expectancy is significantly lower compared to other wealthy nations. He suggests that his role goes beyond verifying actuarial data, urging a deeper evaluation of rate increases in the context of overall healthcare quality and economic conditions. He also noted that the regulatory framework in Rhode Island only covers about 15% of the population, limiting the Health Insurance Commissioner’s impact.

3. Industry and Public Response: In response to Neronha’s critique, Blue Cross mentioned that rising drug costs and increased medical service utilization have led to significant operational losses, justifying their request for rate increases. However, other insurers like Neighborhood Health Plan and UnitedHealthcare have not commented. The Rhode Island Business Group on Health supports Neronha’s perspective, advocating for substantial healthcare reforms and better cost management, emphasizing that the current trajectory of premium increases is unsustainable.

Telehealth takes a tumble, but experts say the fight isn’t over

By Caroline Catherman - Telehealth has taken more hits lately than a piñata at a birthday party. In April, UnitedHealth Group announced it was shutting down its Optum Virtual Care program. Days later, Walmart announced it would shutter both Walmart Health and Walmart Health Virtual Care. Read Full Article…

HVBA Article Summary

1. Financial Challenges in Telehealth: Teladoc's significant financial losses in Q2, highlighted by an $838 million net loss largely attributed to an $800 million impairment charge for its subsidiary BetterHelp, underscore the volatile financial landscape of telehealth providers. The decline was further exacerbated by rising customer acquisition costs, indicating a potential reassessment of telehealth’s economic sustainability and market strategies.

2. Persistent Belief in Telehealth's Value: Despite recent financial turbulence, industry leaders and experts maintain a strong belief in the fundamental value and necessity of telehealth. Kyle Zebley of the American Telemedicine Association emphasized telehealth's permanence, advocating against a return to pre-pandemic norms that limited telehealth access. This sentiment is supported by the substantial increase in telehealth adoption during the pandemic, which saw physician usage jump from 15.4% in 2019 to 86.5% in 2021.

3. Future of Telehealth Regulations and Integration: The looming expiration of pandemic-era Medicare telehealth flexibilities poses a critical juncture for the future of telehealth, with potential extensions by Congress anticipated. However, experts like Sanjula Jain from Trilliant Health critique the efficacy and cost-effectiveness of telehealth as a standalone service, suggesting that its best use may lie in complementing rather than replacing in-person care, a view echoed by Derek Streat of DexCare who advocates for a more integrated approach to healthcare delivery.

6 strategies for improving employee mental health

By Renee Cavallaro - As the 2024 benefits renewal season approaches, a new report sheds light on the complex landscape of employee mental health, highlighting both challenges and opportunities for organizations. The April 2024 TELUS Mental Health Index for the United States reveals a workforce grappling with exhaustion, burnout and motivational hurdles. Read Full Article…

HVBA Article Summary

1. Positive Outlook on AI Integration: The TELUS Mental Health Index reports that 35% of workers believe AI will positively impact their industry. By involving employees from the start and maintaining open communication, organizations can mitigate undue anxieties, promoting a smoother transition that benefits mental wellbeing and productivity.

2. Evidence-Based Strategies for Mental Health: Employers are encouraged to adopt several strategies to support employee mental health, such as proactive burnout management, offering flexible work arrangements, enhancing mental health resources, and involving employees in AI-related discussions and training. These measures aim to address the high levels of exhaustion and burnout reported, particularly among younger and female workers.

3. Comprehensive Mental Health Strategy: To effectively improve mental health outcomes in the workplace, it's essential for employers to combine enhanced resources, proactive burnout prevention, and skills training for new technologies like AI. Creating a culture of wellbeing and integrating mental health metrics into company KPIs are also recommended to build a more supportive and resilient workplace.

Health systems still reeling from Change hack

By Naomi Diaz - While some of the nation's largest health systems have fully recovered from the Feb. 21 ransomware attack on UnitedHealth's Change Healthcare, smaller systems are still grappling with its effects, an Aug. 13 report from Strata Decision Technology found. Read Full Article…

HVBA Article Summary

1. Resilience Among Large Health Systems: The report highlights that the nation's largest health systems, despite experiencing significant impacts from the ransomware attack, demonstrated remarkable resilience and recovery. These systems, with operating expenses exceeding $2.5 billion, managed to reduce their payment shortfalls from around 20% at the end of the first quarter to 5.5% by the end of the second quarter.

2. Continued Struggles for Smaller Systems: In stark contrast, smaller health systems, specifically those with annual operating expenses under $500 million, continue to face substantial financial challenges. As of the end of the second quarter, these systems were still missing 11.1% of their expected Medicare inpatient payments from February, indicating ongoing difficulties in recovery.

3. Differential Recovery Across Sizes: Mid-sized health systems, those with operating expenses between $500 million and $1 billion, showcased the most effective recovery, with only a 1.5% shortfall in Medicare inpatient payments from February. This suggests a varying capacity for rebound across different sizes of health systems, with mid-sized entities faring better than both their smaller and larger counterparts.

What to watch when Medicare releases first negotiated drug prices

By Maya Goldman - The confidential nature of the Biden administration's drug price negotiations has made the process and outcome of the long-sought Democratic policy goal something of a mystery. Read Full Article…

HVBA Article Summary

1. Impending Results and Political Considerations: The Biden administration is set to release the results of drug price negotiations, with a keen eye on the potential savings starting in 2026. This announcement is particularly significant as it unfolds in an election year, raising questions about the administration's firmness in negotiations with the pharmaceutical industry.

2. Future Negotiation Rounds and Industry Impact: While initial drug price negotiations for the first 10 drugs, including major medications like Eliquis and Jardiance, are not expected to heavily impact pharmaceutical companies' bottom lines, they set a precedent for future negotiations. These could expand to include more drugs, potentially affecting prices for major revenue generators like GLP-1 weight-loss drugs.

3. Strategic and Policy Implications: With the announcement expected soon, stakeholders are speculating on how CMS will report savings and the impact of these new prices on various industry players, including pharmacy benefit managers and insurance plans. The positioning of drugs on Medicare Part D formularies could shift, influencing market dynamics and future drug pricing strategies.

Are We Relying Too Much on BMI to Diagnose Obesity?

By Caroline Messer, MD - Gary* is a 60-year-old race car driver with a history of insulin resistance, elevated cholesterol, and severe reflux. His wife sent him to me when his snoring became so loud and "violent" that she could no longer sleep in the same bedroom. Read Full Article…

HVBA Article Summary

1. Central Adiposity Overlooked by BMI: The story illustrates a critical concern in obesity management: the reliance on BMI as a sole indicator for health risks. Despite a BMI of 26.5, which is slightly above normal, the patient's physical examination revealing a hard, protuberant belly suggested a significant health risk, highlighting the inadequacy of BMI in assessing central adiposity. This is underscored by the European Association for the Study of Obesity's (EASO) new guidelines which recommend additional measures like waist-to-height ratio and DEXA scans to better capture cardiometabolic risks associated with visceral fat.

2. New EASO Guidelines and Their Implications: The EASO's July 2024 guidelines propose a redefinition of obesity, emphasizing it as a chronic condition that extends beyond mere BMI figures to include factors like waist-to-height ratios and the presence of visceral fat. This change is aimed at better identifying at-risk patients who, despite having a BMI under the traditional obesity threshold of 30, may still be at significant risk due to their body fat distribution and related comorbidities.

3. Challenges in Implementing New Obesity Guidelines: The narrative of Gary's struggle with weight loss underscores the practical challenges in aligning current medical practice with emerging guidelines. Despite his clear need based on the new criteria (waist-to-height ratio of > 0.6 and elevated fat percentage), Gary's access to appropriate medical interventions like semaglutide was initially hindered by traditional insurance criteria that still adhere to outdated BMI benchmarks. His eventual progress on compounded semaglutide, leading to significant weight loss and health improvement, illustrates the potential benefits of adopting these new guidelines in clinical practice.

Resource Roundup: A Functional Medicine Approach to Irritable Bowel Syndrome

By Avery St. Onge - According to Clevland Clinic, irritable bowel syndrome (IBS) is categorized as a constellation of symptoms affecting the digestive system, such as diarrhea, constipation, bloating, and stomach pain. Generally thought to be a manageable and non-threatening condition, IBS can be extremely uncomfortable, inconvenient, and even debilitating for some patients. Read Full Article…

HVBA Article Summary

1. Prevalence and Complexity of IBS: Experts estimate that 10 to 15 percent of the U.S. population suffers from Irritable Bowel Syndrome (IBS), underscoring its prevalence. However, the mechanisms behind IBS remain poorly understood, which complicates efforts to find effective treatments. This lack of understanding highlights the necessity for personalized approaches in managing the condition.

2. Limitations of Pharmaceuticals: Traditional pharmaceutical treatments have not been particularly successful in managing IBS, leading healthcare providers and patients to explore integrative medicine approaches. This shift reflects a growing recognition that a one-size-fits-all strategy is insufficient for a complex condition like IBS.

3. Integrative Medicine Approaches: The article provides an overview of several promising integrative interventions for IBS. These include the use of dietary supplements, specific dietary changes, and innovative techniques such as vagus nerve stimulation. Each approach is tailored to individual patient needs and is part of a holistic strategy to manage the symptoms of IBS more effectively.