Biden admin's final Unified Agenda includes release dates for several health care regulations

By Alan Goforth - Regulations issued by federal agencies can have as great of an impact on the health care industry as the broader laws passed by Congress and signed by the president. The Biden administration has released its final so-called Unified Agenda, which provide a list of regulations that federal departments are working on and their expected release dates. Read Full Article…

HVBA Article Summary

1. Mental Health Parity: The administration proposed regulations in July 2023 to enhance access to mental health and substance-use disorder benefits by ensuring compliance with mental health parity requirements. Employers and insurance carriers have expressed concerns about the complexity of new definitions and mathematical tests designed to ensure parity. The anticipation for the final regulations is high, with an expected release date later this month, as indicated by the Unified Agenda.

2. Surprise Billing Requirements: In response to feedback regarding the federal surprise billing payment process, new regulations were proposed in October 2023. These regulations aim to formalize the open negotiation period, necessitate the inclusion of health claim numbers and other specific details on negotiation and dispute resolution notices, and adjust the handling of service codes in batched claims. The medical community views these as beneficial modifications, although the finalization of these rules has been delayed until November, with regulations concerning air ambulance services postponed to March 2025.

3. HIPAA Privacy and Cybersecurity Enhancements: For the first time, federal agencies are drafting HIPAA regulations to bolster cybersecurity protections for medical providers, health plans, and third parties managing personal health information. The proposed regulations, expected to be released in December, reflect a growing recognition of the importance of safeguarding health data against cyber threats, as outlined in the Unified Agenda.

US judge strikes down Biden administration ban on worker 'noncompete' agreements

By Daniel Wiessner - A federal judge in Texas on Tuesday barred a U.S. Federal Trade Commission rule from taking effect that would ban agreements commonly signed by workers not to join their employers' rivals or launch competing businesses. Read Full Article…

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1. Ruling Against the FTC’s Authority: U.S. District Judge Ada Brown ruled that the Federal Trade Commission (FTC) does not have the authority to implement broad rules against what it considers unfair competition methods. This decision came after the U.S. Chamber of Commerce and tax service firm Ryan challenged the FTC's rule that aimed to ban nearly all noncompete agreements. Judge Brown highlighted that the rule was both arbitrary and capricious due to the FTC's failure to provide sufficient evidence for imposing such an extensive prohibition.

2. FTC's Response and Potential Appeal: Despite the setback, the FTC expressed disappointment with the ruling and is contemplating an appeal. FTC spokesperson Victoria Graham emphasized that the ruling does not preclude the Commission from tackling noncompete issues through individual enforcement actions, suggesting that the FTC will continue to address these agreements on a case-by-case basis.

3. Impact and Reaction from Business Groups: The decision was met with approval from business circles, with Suzanne Clark, President and CEO of the Chamber of Commerce, describing it as a victory against government overreach in business decisions. The FTC had previously argued that noncompete agreements unduly restrict competition and suppress workers’ wages and mobility, affecting an estimated 30 million workers. Business groups, however, contend that such broad regulatory powers were never intended by Congress and that noncompete agreements are essential for protecting trade secrets and other confidential business information.

‘Great on Paper’: Why Primary Care Physicians Are Reluctant To Join Value-Based Care

By Marissa Plescia - While value-based payment models seem great in theory, research shows that many primary care providers aren’t partaking in these models. Over the last 14 years, the Centers for Medicare and Medicaid Services (CMS), as well as several states, have introduced value-based care models directed at primary care. Read Full Article…

HVBA Article Summary

1. Adoption Challenges and Interest in Value-Based Care (VBC): Despite primary care physicians showing strong interest in value-based care models, which prioritize quality over quantity of services, their adoption is hindered by financial barriers, workforce shortages, and extensive documentation requirements. Smaller practices, particularly in rural areas, struggle with inadequate funding and resources, making it difficult to implement these models effectively.

2. Key Barriers to Implementation: Financial limitations are significant, with commercial payers contributing minimally to funding changes necessary for VBC. Additionally, the complexity and variability of VBC arrangements among payers create a heavy administrative burden. These factors, combined with a critical workforce shortage and an overload of quality measure documentation, significantly impede the widespread adoption of VBC, especially among small and rural practices.

3. Proposed Solutions for Effective Implementation: To facilitate a smoother transition to value-based care, the report and experts suggest increasing upfront payments to primary care providers, enhancing resource allocation within health systems, and revising payment structures to better compensate primary care relative to specialties. Additionally, simplifying performance measures and reducing the emphasis on documentation could help focus more on patient care and less on administrative tasks.

Cancer poses a growing problem for employers

By Tina Reed - Rising cancer rates among younger workers are a new factor clouding employers' health cost outlook, per a major benefits survey released Tuesday. Read Full Article…

HVBA Article Summary

1. Increasing Health Care Costs Due to Cancer: In 2024, cancer emerged as the most reported condition escalating health care costs, surpassing both musculoskeletal and cardiovascular conditions. A significant 72% of large employers noted a higher prevalence of cancer among their workforce and their families, according to a survey by the Business Group on Health. This rise in cancer cases contributes to the mounting health care expenses faced by employers and highlights the ongoing challenge of managing chronic health conditions in the workplace.

2. Impact of Specialty Drugs and Catastrophic Claims: The financial strain on health care systems is further exacerbated by the costs associated with specialty drugs and catastrophic health claims, which were significant factors for 20% of employers in a recent survey by the International Foundation of Employee Benefit Plans. The increasing use of expensive treatments correlates with the rising incidence of cancer, indicating a direct impact on health care affordability and accessibility.

3. Delayed Cancer Care and Demographic Changes: The COVID-19 pandemic led to delayed access to cancer screenings and preventative services, contributing to an uptick in cancer diagnoses, particularly among younger populations. Brenna Shebel, vice president at the Business Group on Health, notes the troubling trend of increased cancer rates in younger demographics, which poses additional challenges for those balancing career, family, and caregiving responsibilities. This demographic shift suggests a future where more individuals may face significant health battles earlier in life, along with a higher lifetime risk of experiencing treatment-related side effects.

J.D. Power: Brick-and-mortar pharmacies ceding ground to mail-order options on consumer satisfaction

By Paige Minemyer - While customer satisfaction with mail-order pharmacies is continuing to grow, brick-and-mortar pharmacies are falling behind, according to a new survey from J.D. Power. The firm's annual Pharmacy Study found that retail pharmacies saw overall satisfaction scores decrease by more than 10 points, while scores for mail-order pharmacies grew by six. The survey found consumers visiting brick-and-mortal facilities are facing long wait times and issues in ordering prescriptions, which is worsening the experience. Read Full Article…

HVBA Article Summary

1. Communication Strengths and Trust Gaps: Brick-and-mortar pharmacies excel in clear communication, with 89% of customers satisfied with how pharmacists convey messages. However, despite effective communication, there exists a significant trust gap, as only 51% of customers perceive their pharmacist as trustworthy and report that prescriptions are filled quickly.

2. Enhancing Trust Through Personalized Service: According to Christopher Lis, Ph.D., of J.D. Power, building customer trust hinges on the presence of responsive and committed staff. Personalized service, including recognizing customers by name, timely and accurate product delivery, and handling delays effectively, are crucial for fostering trust and improving the overall consumer experience.

3. Challenges and Opportunities for Digital Pharmacies: While brick-and-mortar locations struggle with trust, digital pharmacies face their own challenges, including a knowledge gap and a lack of engagement due to poor digital experiences—only 18% of consumers are satisfied with the digital interface of their pharmacies. To overcome these obstacles, Lis suggests that digital pharmacies could benefit significantly from establishing comprehensive FAQ sections on their websites to address common concerns and clarify issues regarding insurance and service reliability.

Mental health crisis driving $14T health care cost

By Kristen Beckman - People with mental health diagnoses face higher rates of chronic illnesses, highlighting the interconnectedness of mental and physical health, according to a new report from the Meharry School of Global Health and the Deloitte Health Equity Institute. The report found mental health inequities across the United States could lead to $14 trillion in costs between now and 2040 if not addressed. Read Full Article…

HVBA Article Summary

1. Disproportionate Burden of Chronic Conditions: Lower-income individuals and racial and ethnic minorities face a disproportionate burden of chronic conditions such as diabetes, stroke, hypertension, ischemia, and HIV. This burden is compounded by higher rates of mental health challenges, leading to increased health care spending and reduced productivity, particularly among these marginalized groups.

2. Worsening Trends in Mental Health: The report highlights a significant rise in mental health challenges, with antidepressant prescriptions increasing markedly among adults and adolescents between 2015 and 2019. The trends in mental illness and substance use disorders have further escalated since the onset of the pandemic in 2020, exacerbating the mental health crisis perceived by 90% of Americans.

3. Strategies for Mitigating Mental Health Impacts: To combat the escalating mental health crisis, integrated care approaches are recommended. These approaches can help reduce cultural stigma, enhance access to mental health services, and lower overall health care costs. By improving economic stability and workforce participation, integrated care models address both the symptoms and root causes of mental health disparities.

Mounjaro, Zepbound Cut Odds for Diabetes by 94% in At-Risk People, Study Finds

By Ernie Mundell - Tirzepatide, the blockbuster GLP-1 medicine known as Mounjaro for diabetes and Zepbound for weight loss, cut the odds that an obese, prediabetic person will develop diabetes by 94%, a new trial shows. Read Full Article…

HVBA Article Summary

1. Significant Weight Loss Observed: The trial demonstrated that tirzepatide effectively promotes weight loss in individuals with obesity and prediabetes. Participants on the highest dose of 15 mg experienced a remarkable 22.9% reduction in body weight over three years, significantly higher than the 2.1% weight loss seen in those receiving a placebo.

2. Potential Benefits in Diabetes Prevention: Alongside weight loss, the study highlighted tirzepatide's role in potentially delaying or preventing the onset of type 2 diabetes. After stopping treatment, those who had taken tirzepatide showed an 88% reduced risk of progressing to type 2 diabetes compared to placebo, despite some weight regain.

3. Manageable Side Effects: Despite the substantial benefits, the treatment was associated with side effects, predominantly gastrointestinal issues like nausea and diarrhea. These adverse events were generally described as mild to moderate, suggesting that tirzepatide could be a tolerable long-term treatment option for those managing obesity and prediabetes.

ICHRAs might be adding to individual health sales: Mark Farrah

By Allison Bell - Employer-sponsored individual coverage health reimbursement arrangement plans might finally be showing up in health coverage enrollment statistics, four years after the start of the COVID-19 pandemic ruined their original debut. Read Full Article…

HVBA Article Summary

1. Rapid Growth in Individual Health Enrollment: Analysts from Mark Farrah Associates have identified a significant increase in individual health coverage enrollment, rising from 21.2 million to 24.3 million from March 2023 to March 2024. This increase is notable despite some insurers exiting or scaling back their participation in the individual market. The analysts attribute part of this growth to the adoption of Individual Coverage Health Reimbursement Arrangements (ICHRAs) by employers, suggesting that these arrangements now represent a substantial segment of the market.

2. Shift in Employer-Sponsored Coverage Trends: The analysis indicates a shift in how Americans are receiving their health coverage. While individual enrollment surged by 3.2 million, enrollment in traditional employer-sponsored group health plans decreased by 1.5 million during the same period, which was characterized by a robust labor market. This trend supports the hypothesis that the rise in individual coverage may be driven by increased employer reliance on ICHRAs.

3. Evolution of Cash-for-Coverage Health Plans: The landscape for employer-sponsored health benefits has undergone significant changes over the past decades. With the introduction of the Affordable Care Act in 2014, barriers such as medical underwriting were removed, facilitating the creation of cash-for-coverage plans like ICHRAs. These plans were further bolstered by legislative and regulatory developments, including the 21st Century Cures Act and actions by federal agencies in 2019, making them accessible to a broader range of employers. The ongoing adaptations in these plans, coupled with the impact of COVID-19, suggest a potential resurgence in employer interest in flexible health coverage solutions like ICHRAs and QSEHRAs moving forward.

Sugar Substitutes, Originally Meant to Reduce Health Risk, May Wreak Havoc on Gut Microbiomes

By Brandy W. Root, RDN - Commercial sugar substitutes have been used since the late 1800s when saccharin was accidentally developed by a chemist at Johns Hopkins University. Due to widespread sugar rationing during World Wars I and II, saccharin grew in popularity. Read Full Article…

HVBA Article Summary

1. Impact on Health and Microbiome: Artificial sweeteners like saccharin, aspartame, and sucralose have been deemed safe by regulatory bodies, but recent studies suggest they may disrupt gut microbiota, leading to inflammation, poor glycemic control, and increased antibiotic resistance. Some, like sucralose, have even been shown to have potential genotoxic effects in experimental models.

2. Variability Among Sugar Substitutes: While some nonnutritive sweeteners adversely affect the gut microbiome and overall health, others like glycyrrhizin and erythritol show potential benefits. Glycyrrhizin, for instance, enhances gut health with its antimicrobial and anti-inflammatory properties, whereas erythritol has been noted to improve glucose tolerance despite its links to increased cardiovascular risks at high blood levels.

3. Recommendations for Sugar Intake Reduction: Health professionals often advise reducing both sugar and artificial sweeteners to combat obesity and metabolic diseases effectively. Strategies such as gradually mixing sweetened and unsweetened beverages and exploring naturally less sweet alternatives like herbal teas can help patients adapt to lower sugar levels, enhancing taste sensitivity and overall health.