The U.S. Chamber of Commerce: From Fighting Obamacare to Defending Big Pharma

By Joey Retting - To tell you the truth, I don’t even remember the passage of the Affordable Care Act, a landmark piece of legislation aimed at expanding health care coverage for Americans and curtailing insurance industry business practices. The ACA, or Obamacare, was passed in 2010 when I was in high school and still on my mother’s employer-sponsored health insurance plan. Read Full Article…

HVBA Article Summary

1. Millennial Influence in Healthcare Policy: A significant portion of congressional staffers, who are mainly millennials (approximately 60% under the age of 35), were just teenagers during the enactment of the Affordable Care Act (ACA). Their youthful perspective is now pivotal as they influence healthcare policy, potentially without a detailed recollection of the contentious debates that characterized the ACA’s passage over a decade ago.

2. U.S. Chamber of Commerce's Role: Historically, the U.S. Chamber of Commerce has been a formidable force in healthcare debates, known for its substantial financial influence and membership with giants like Pfizer and Google. In 2010, the Chamber, backed by $100 million from America's Health Insurance Plans (AHIP), actively opposed the ACA. More recently, in 2023, it challenged Medicare's drug price negotiation program, claiming it was unconstitutional, reflecting its consistent strategy to protect industry profits over consumer interests.

3. Broader Implications and Generational Memory: The article reflects on the cyclical nature of policy debates and the influence of powerful lobbies like the U.S. Chamber of Commerce, which often prioritizes corporate interests. It highlights the potential for generational shifts in memory and understanding of such debates, with a future where today's actions by entities like the Chamber may be forgotten by incoming generations, such as Gen Z congressional staffers, even as they live with the policies' impacts.

Aon projects employer health costs will rise 9% next year

By Paige Minemyer - Employers' health costs are expected to rise by an average of 9% next year, according to a new report from Aon. The analysts estimated that the average cost for employer-sponsored care would top $16,000 per employee in 2025. Read Full Article…

HVBA Article Summary

1. Rising Costs and Employer Responses: The estimated 9% increase in employer healthcare costs for 2025 is significantly higher than the previous year's increase of 6.4%. This figure does not account for potential cost-saving strategies such as increased employee cost-sharing, which employers may deploy in 2025. In 2024, employees contributed on average $4,858 towards their health coverage, highlighting a continued trend of rising costs both for employers and employees.

2. Factors Driving Cost Increases: According to Debbie Ashford from Aon, key factors driving the uptick in healthcare costs include higher employment levels, wage increases spurred by inflation, and higher negotiated healthcare prices. Additionally, elevated medical claim levels and increasing prescription drug costs, particularly for specialty medications and GLP-1s, are significant contributors. The increased demand for GLP-1s is expected to result in a 1% aggregate increase in healthcare costs.

3. Impact on Plan Participants: Despite the rising costs, employers like those surveyed by Aon are cautious about shifting too much financial burden onto employees. The average out-of-pocket costs for employees rose by 3.4% in 2024, compared to the annual average growth of 1.2% in the preceding five years. This cautious approach aims to maintain the affordability of health benefits amid escalating healthcare expenses.

What Will the Future of Retail Health Look Like?

By Katie Adams - There is no shortage of stories that warn us about the perils of overambition. But perhaps the executives at the nation’s largest retailers — in their quest to master primary care by banking on their consumer expertise — have never come across Don Quixote, Macbeth or Icarus. Read Full Article…

HVBA Article Summary

1. Reevaluation of Healthcare Strategies by Major Retailers: Top retailers like Walmart and Walgreens are reassessing their involvement in direct healthcare delivery. Walmart has discontinued its healthcare services, and Walgreens announced its plan to reduce its stake in VillageMD. Despite some retailers continuing to operate their healthcare clinics, such as Amazon with One Medical and CVS with Oak Street Health, the success of these ventures has been limited, highlighting a challenging landscape for retail-based healthcare.

2. Shift Towards Trust and Preventive Care: Industry experts suggest that for retail health initiatives to be successful, there needs to be a fundamental shift towards building trust and focusing on preventive care rather than just sick care. Neal Batra of Deloitte Consulting emphasizes the importance of engaging consumers before they need care and focusing on services like vaccinations and wellness programs that promote long-term health management.

3. Exploration of New Models and Partnerships: Retailers are exploring different models to salvage and enhance their healthcare ventures. Some, like CVS, are integrating value-based care to improve efficiency and patient outcomes, particularly through their acquisition of Aetna and the expansion of Oak Street Health centers. Others, such as Walmart and Walgreens, are forming partnerships with health systems and digital health startups to leverage their extensive consumer base and retail presence more effectively, moving away from direct ownership to strategic collaborations that might offer more sustainable benefits.

How Digital Delivery Can Empower Staff and Shape the Future of Pharmacy 

By Matt Feltman - When patients pick up a prescription medication (or have one delivered), two things typically happen. First, the individual is asked if they want counseling from, or have any questions for, the pharmacist. Second, a sheaf of papers is stapled to the bag the medication is placed in. The papers feature information about the type of medication that has been prescribed, what it is for, and side effects to look out for. Read Full Article…

HVBA Article Summary

1. Reversing the Order for Better Outcomes: Typically, patients receive printed medication instructions at the pharmacy upon pickup, often leading to unread information and missed opportunities for clarification. By delivering digital information before the prescription is ready, patients can review details in advance, come prepared with questions, and engage meaningfully with pharmacists, enhancing understanding and adherence to medication regimes.

2. Efficiency and Cost Savings: Pharmacies face significant financial pressures from rising drug costs and decreased reimbursements. Switching to digital solutions not only reduces paper and printing costs but also streamlines operations by cutting down time spent on manual tasks like collating instructions. This shift allows pharmacists to focus more on patient care and less on repetitive tasks, improving overall efficiency.

3. Environmental Impact and Sustainability: Traditional pharmacy practices, including extensive use of paper and plastic, have a notable environmental footprint. Transitioning to digital patient education materials reduces paper use, saves trees, and decreases waste from toner cartridges. By adopting more sustainable practices, pharmacies can demonstrate a commitment to environmental responsibility while still providing essential health services.

Medical Stop-Loss Strategies in Captive Insurance

By Ann Marie Towle - Medical researchers continue to develop extraordinary treatments capable of saving patients' lives. Unfortunately, while these treatments are great for patients' health, they can be downright deadly for the health insurance plans offered by their employers. From gene therapy to new medications, the high cost of these innovative therapies is leading employers to look for a cure of their own. Read Full Article…

HVBA Article Summary

1. Introduction to Captive Medical Stop-Loss Insurance: As healthcare costs for long-term and specialty medications skyrocket, employers who self-fund their employee benefit plans face the challenge of managing substantial claim amounts, potentially reaching six or seven figures. One strategic solution is the establishment of a captive medical stop-loss insurance program. This approach provides a shield against exorbitant claims, leveraging the inherent flexibility and financial benefits of captive insurance companies to turn what could be a recurring expense into a valuable investment.

2. Benefits and Structures of Captive Insurance: Captive insurers offer various structures to suit different organizational needs—ranging from cell captives for simplicity and quick setup, to single-parent captives for individual companies, and group captives that spread costs and risks among multiple companies. These captives not only help in controlling escalating healthcare costs but also enable customization of benefits to meet the specific needs of employees. Engaging with an experienced captive insurance consultant is recommended to navigate the choices and optimize the captive’s performance.

3. Leveraging Data for Strategic Management: With the advent of pricing transparency and advancements in data analysis and artificial intelligence, plan managers now have unprecedented access to comprehensive benefit-related data. This information allows for detailed comparisons and pattern recognition that were previously impossible, aiding in making informed decisions about healthcare spending. By analyzing data like medical spend by diagnosis and pharmacy costs, captive insurance programs can effectively reduce risk and enhance the sustainability of healthcare benefits, ultimately ensuring employees receive necessary care without compromising the financial health of the business.

Private equity firms are health care guppies: Vanguard managers

By Allison Bell - Two Vanguard managers scoff at the idea that private equity-backed firms dominate the U.S. health care provider sector. Private equity-backed companies will generate only about 3% of U.S. health care provider revenue this year, and private equity firms have not made a large investment in a U.S. hospital or health care system since 2018, according to a midyear private equity review by Michael Rabinovich and Matt Schweitzer. Read Full Article…

HVBA Article Summary

1. Current Private Equity Trends in Healthcare: According to Rabinovich and Schweitzer, private equity deal activity in the healthcare sector, specifically in hospitals and skilled nursing homes, is currently minimal. They attribute this trend to a misconception perpetuated by the media about the overwhelming influence of private equity investments in healthcare organizations.

2. Comparison of Ownership Outcomes: The duo argues that academic research supports their claim that there are no significant differences in health outcomes between facilities owned by private equity firms and those owned by other types of owners. They note that facilities with private equity ownership even reported lower infection and death rates, challenging the negative narrative often associated with private equity in healthcare.

3. Implications for the Healthcare Industry: The findings suggest that private equity firms, contrary to popular belief, may have a modest but beneficial impact on the U.S. healthcare system. For stakeholders such as employers and brokers, understanding the nuanced role of private equity could lead to more informed decisions about engaging with these investors in the healthcare space.

Weight loss drugs could cost Medicare $6B a year: Study

By Rylee Wilson - Medicare spending could increase between $3.1 billion and $6.1 billion annually if the program covers GLP-1 drugs for weight loss, a study published Aug. 15 in Health Affairs found. Under current law, Medicare cannot pay for any drug prescribed solely for weight loss. Read Full Article…

HVBA Article Summary

1. Eligibility and Cost Implications: The study estimates that 10.9 million Medicare beneficiaries diagnosed with obesity or overweight would become eligible for GLP-1 weight loss drugs if Medicare expands its coverage. Depending on the uptake—5% or 10% of these beneficiaries—the annual increase in Medicare costs could be $3.1 billion or $6.1 billion respectively. These drugs, which include Wegovy and Zepbound, typically cost over $10,000 per year without insurance.

2. Legislative Developments: The House Ways and Means Committee recently advanced a proposal that would allow Medicare to cover weight loss drugs for beneficiaries who had been prescribed these drugs for at least a year before transitioning to Medicare. This move could potentially increase access to these medications for a significant number of elderly and disabled Americans.

3. Market Dynamics and Cost Management: The introduction of Zepbound is expected to exert downward price pressure on its competitor, Wegovy, which could lead to reduced prices over time. Additionally, the authors anticipate that GLP-1 drugs will be targeted for Medicare price negotiations in the future, potentially further lowering costs. This approach aligns with the ongoing efforts to manage and reduce the financial burden of new, high-cost medications on the Medicare system.

Government Accuses Health System of Paying Docs Outrageous Salaries for Patient Referrals

By Alicia Gallegos - Strapped for cash and searching for new profits, Tennessee-based Erlanger Health System illegally paid excessive salaries to physicians in exchange for patient referrals, the US government alleged in a federal lawsuit. Read Full Article…

HVBA Article Summary

1. Compensation and Referral Practices in Question: Erlanger Health System changed its compensation model to attract revenue-generating specialists by offering salaries significantly above the median for their fields. According to a government lawsuit, this strategy led to increased patient referrals within the system, which were then billed to Medicare, allegedly violating the Stark Law that prohibits improper financial relationships influencing medical decisions.

2. Legal and Regulatory Scrutiny: The lawsuit serves as a cautionary tale for healthcare providers, emphasizing the risks of financial arrangements that could potentially influence physician referrals and compromise medical judgment. Special Agent Tamala E. Miles from the HHS Office of Inspector General highlighted ongoing efforts to investigate and prevent such arrangements that could escalate healthcare costs and undermine public trust.

3. Erlanger’s Response and Broader Implications: Despite the allegations, Erlanger denies any wrongdoing, asserting that their compensation practices were based on fair market values confirmed by external experts and did not involve paying for referrals. This case underscores the importance of healthcare entities maintaining robust compliance measures, and serves as a reminder to physicians to independently verify the legality and ethics of their contractual arrangements with hospitals.

Research Highlights Risks of Severe Reactions from Common Antibiotics

By Avery St. Onge - A recent study has identified that two widely prescribed classes of oral antibiotics are linked to a significantly increased risk of severe drug rashes, which can lead to emergency department visits, hospitalizations, and even death. The research was conducted by teams from the Institute for Clinical Evaluative Sciences (ICES), Sunnybrook Research Institute, and the Department of Medicine at the University of Toronto’s Temerty Faculty of Medicine, and it underscores the importance of careful antibiotic prescribing practices. Read Full Article…

HVBA Article Summary

1. Incidence and Mortality of cADRs: The study highlights the rare yet severe nature of cutaneous adverse drug reactions (cADRs), which can affect both the skin and internal organs, and are associated with a high mortality rate of 20-40%. Focused on older adults, a population more prone to antibiotic prescriptions, the research confirms antibiotics, particularly sulfonamides and cephalosporins, as frequent triggers of these life-threatening reactions.

2. Methodology and Key Findings: Utilizing healthcare data from Ontario, Canada, covering adults aged 66 and older between 2002 and 2022, researchers analyzed outcomes for 21,758 individuals who experienced serious cADRs leading to emergency or hospital care, compared to 87,025 controls without such reactions. The data showed a significantly increased risk of cADRs with all antibiotic classes compared to macrolides, with two hospital visits linked to cADRs per 1,000 antibiotic prescriptions.

3. Implications and Preventive Measures: The study underscores the critical need for cautious antibiotic prescribing and vigilance for symptoms like rash and fever that may appear weeks after treatment initiation. By prioritizing the use of lower-risk antibiotics and prescribing them only when necessary, healthcare providers can better safeguard against the severe outcomes of cADRs, potentially reducing the rate of intensive care admissions and fatalities associated with these reactions.