The 3 conditions driving healthcare costs up for employers: Report

By Mariah Taylor - Pharmacy, cancer and musculoskeletal conditions remain the top drivers of increased healthcare costs for employers, but cardiovascular conditions are on the rise as well, a Business Group on Health report found. Read Full Article…

HVBA Article Summary

1. Projected Increase in Healthcare Costs: The "2025 Employer Health Care Strategy Survey" by Business Group of Health, involving 125 large employers covering 17.1 million workers, revealed a projected near 8% increase in healthcare costs for 2025—the highest in over a decade. This rise is driven by the demand for expensive drugs, like GLP-1s, and the ongoing treatment of chronic conditions including cancer.

2. Employer Response to Rising Costs: Despite the surge in healthcare costs, employers are committed to maintaining comprehensive healthcare benefits. According to Ellen Kelsay, president and CEO of Business Group on Health, employers are absorbing much of the cost increases while focusing on strategies to reduce expenses and enhance employee health outcomes and experiences.

3. Strategic Adjustments and Concerns: The survey highlighted significant employer concerns and strategic adjustments, noting that 76% of employers are very worried about escalating pharmacy costs, which grew from 21% of healthcare spending in 2021 to 27% in 2023. Employers are also exploring non-traditional health plans and transparent pharmacy benefit management to control costs, alongside prioritizing improved access to mental health services and preventive measures for conditions like cancer.

More Than Half of IRA Negotiation Savings to Come From Three Drugs: Report

By Tristan Manalac - Amgen’s Enbrel, Bristol Myers Squibb’s Eliquis and Johnson & Johnson’s Stelara will account for 51.4% of the Inflation Reduction Act’s drug price negotiation savings in 2026, according to the Brookings Institution. Read Full Article…

HVBA Article Summary

1. Significant Savings from a Few Key Drugs: The Inflation Reduction Act's Medicare Drug Price Negotiation Program is projected to save approximately $6 billion, with over half of these savings ($3.28 billion) coming from just three drugs: Amgen’s Enbrel, Bristol Myers Squibb’s Eliquis, and Johnson & Johnson’s Stelara in 2026. These drugs alone will account for 51.4% of the total expected savings.

2. Variable Impact of Negotiations: The negotiations under the Inflation Reduction Act have reduced drug prices by an average of 22%, after accounting for drugmakers' rebates. However, the impact varies significantly among drugs, with more substantial price reductions on drugs that faced less competitive market forces prior to the Act. For drugs with large pre-existing rebates, negotiated prices might even fall below the statutory ceiling price.

3. Challenges and Critiques: Despite the projected savings, some stakeholders have expressed concerns regarding the effectiveness of the price reductions. Critics, like Peter Rubin from No Patient Left Behind, argue that using list prices for savings calculations might not translate into lower out-of-pocket costs for Medicare beneficiaries, suggesting that the actual market prices—which are often lower due to rebates and other factors—should be considered to gauge the real benefit to consumers.

Turning 65 soon? Here’s what you need to know about Medicare options and planning for the future

By Amanda McElfresh - Turning 65 is a milestone in anyone’s life. It’s an age when people reflect on their accomplishments, consider the next stage of their professional career and look for ways to carve out more time for family, hobbies and travel. The age of 65 can also have financial implications, since nearly all Americans are eligible for Medicare once they reach that birthday. Read Full Article…

HVBA Article Summary

1. Early Planning for Retirement and Medicare: Ann Booth and Khali Crumpton from Blue Cross and Blue Shield of Louisiana stress the importance of adults planning for their life at age 65 and beyond about a year in advance. Key decisions include whether to continue working and when to start taking Social Security. Nine months before turning 65, individuals should explore their health insurance options, choosing between Original Medicare, Medicare Advantage, or a Medicare supplement plan, with decisions finalized three months prior to their birthday.

2. Understanding Employer Insurance and Medicare Costs: For those planning to continue working past 65, Booth highlights the importance of understanding employer-based insurance coverage. If the employer has more than 20 people, individuals can opt to stay on the employer’s plan. Otherwise, signing up for Medicare with credible Part D coverage is essential to avoid penalties. Crumpton notes the monthly cost of Medicare Part B as a significant factor in deciding whether to stay on employer insurance or switch to Medicare.

3. Personalizing Medicare Choices Based on Needs and Costs: Both Booth and Crumpton emphasize the need to personalize Medicare choices based on individual health needs, financial situations, and lifestyle preferences, such as travel frequency and the desire to stay with existing healthcare providers. They recommend discussing options with a benefits specialist who can provide tailored advice without pressure, ensuring that choices are well-informed and best suited to the individual’s circumstances.

Eli Lilly’s weight loss drug slashes the risk of developing diabetes in long-term trial

By Annika Kim Constantino - Eli Lilly’s highly popular weight loss drug reduced the risk of developing Type 2 diabetes by 94% in obese or overweight adults with prediabetes compared with a placebo, according to initial results from a long-term study released Tuesday. Read Full Article…

HVBA Article Summary

1. Impressive Diabetes Prevention Results: Eli Lilly's tirzepatide demonstrated a substantial 94% reduction in the risk of developing Type 2 diabetes among obese or overweight adults with prediabetes in a long-term study. This effect underscores tirzepatide's potential as a preventive treatment against Type 2 diabetes, which affects a significant portion of the U.S. population with prediabetes.

2. Sustained Weight Loss and Broader Health Benefits: Participants in the study experienced a significant average weight loss of 22.9% over approximately three years when treated with the highest weekly dose of tirzepatide. The study also highlighted the broader potential health benefits of GLP-1 class drugs, which include appetite regulation and improved blood sugar control, addressing issues beyond weight loss like heart failure, sleep apnea, and fatty liver disease.

3. Future Directions and Long-term Impact: The pharmaceutical giant plans to publish the findings in a peer-reviewed journal and present them at a medical conference later in the year. Despite the end of the study showing some weight regain and diabetes progression post-treatment, the maintained 88% lower risk of developing diabetes suggests long-term benefits from tirzepatide therapy. This points to the importance of ongoing treatment for sustaining the health advantages.

Screening cancers carries annual price tag of $43 billion, study finds

By Alan Goforth - Although cancer screening saves lives, it comes at a high cost. Americans spend at least $43 billion each year on tests that check for five major cancers, according to a new study published in the Annals of Internal Medicine. Read Full Article…

HVBA Article Summary

1. Cost Analysis and Effectiveness: Researchers, including Dr. Michael Halpern of the National Cancer Institute, analyzed screening costs for major cancers, revealing a total expenditure of $43.2 billion in 2021. Despite this high figure, the cost of screening was found to be less than the cost of treating cancer within the first year of diagnosis, suggesting that early detection could be more cost-effective.

2. Debate on Screening Value: There is a divide among medical experts about the value of cancer screenings. While Karen Knudsen of the American Cancer Society argues that the benefits of early detection, such as improved survival rates, justify the costs, skeptics like Dr. Adewole Adamson question the true value and effectiveness of these screenings, highlighting an overestimation of benefits by the public.

3. Impact of Screenings on Cancer Rates: The study sparks further discussion about the role of screenings in cancer prevention, particularly with findings like those from Dr. David Lieberman, who noted that procedures like colonoscopies not only detect but can prevent colon cancer. However, Dr. Gilbert Welch pointed out that significant declines in cancer death rates over decades might be influenced by factors other than screening, suggesting that the efficacy of screenings may not be as impactful as presumed.

Many prescriptions for acute sinusitis do not follow guidelines

By Stephen Feller - More than half of antibiotic prescriptions for acute sinusitis follow prescribing guidelines, but nearly one-third do not, and most prescriptions are given for too long a duration, according to a study. Read Full Article…

HVBA Article Summary

1. Guideline Concordance and Discordance: While over half (53%) of the 4.7 million sinusitis encounters adhered to guidelines for antibiotic type, nearly one-third did not, often involving macrolides and cephalosporins which are not recommended due to resistance and variability in effectiveness against common pathogens. This indicates a significant gap in adherence to established clinical guidelines for treating acute sinusitis.

2. Impact of Setting and Duration on Prescription Practices: Rural adults and those visiting urgent care settings were more likely to receive prescriptions that did not align with the recommended duration. Moreover, most first-line and second-line antibiotics were prescribed for durations exceeding seven days, contrary to evidence suggesting shorter courses are equally effective.

3. Opportunities for Improvement: Axel A. Vazquez-Deida highlighted the need for targeted antibiotic stewardship interventions to reduce unnecessary and improperly extended antibiotic prescriptions, particularly in urgent care and rural settings. Implementing strategies like delayed prescribing and watchful waiting could optimize treatment and potentially reduce the risk of antibiotic resistance.

Can your employees afford their health plan?

By Deanna Cuadra - Health insurance doesn't necessarily protect members from incurring medical debt, and Americans know this all too well. An estimated 92% of the U.S. has health insurance at some point during the year, according to the U.S. Census. Yet, according to health plan provider Centivo, one in five households has medical debt. Americans collectively owe at least $220 billion in medical debt, and the number is likely to keep climbing as healthcare prices and premiums go up. Read Full Article…

HVBA Article Summary

1. Perception Gap and Financial Barriers: According to Ashok Subramanian, CEO of Centivo, there is a significant discrepancy between employers’ and employees’ satisfaction with health plans. While 83% of employers believe their workforce is satisfied, only 61% of employees feel the same. Subramanian emphasizes that many employers, being on the higher end of the pay scale, may not grasp the financial hardships faced by average employees. For instance, a third of Americans cannot afford a $400 emergency expense, making regular healthcare, especially specialist consultations, financially burdensome under poor coverage conditions.

2. Primary Care Accessibility and Cost Efficiency: Subramanian advises that primary care should be the backbone of any health plan due to its cost-effectiveness and role in early disease detection and management. However, he points out that low engagement in primary care is often due to its high costs, deterring employees from seeking necessary care until conditions worsen, thereby increasing overall medical costs. He argues for the integration of primary care into health plans at no additional cost, suggesting that this approach not only lowers the cost of care by 20% to 30% but also ensures better health outcomes.

3. Need for Employer Self-Awareness and Plan Reevaluation: The key to improving health plans, according to Subramanian, lies in employers becoming more self-aware of the gaps in satisfaction and the actual utility of the health plans they offer. He stresses that employers need to analyze how employees use their health plans and adjust the plans to ensure affordability and accessibility. Subramanian concludes that embracing innovative approaches to healthcare provision, like offering low or no-cost primary care, could bridge the satisfaction gap and lead to substantial savings and healthier employees.

Experts debate: Are HDHPs still a valid cost-saving option?

By Robert Bloink and William H. Byrnes - We asked two professors and authors of ALM's Tax Facts with opposing political viewpoints to share their opinions about whether HDHPs provide a valuable money-saving option for employees and employers. Read Full Article…

HVBA Article Summary

1. Advantages of High Deductible Health Plans (HDHPs) and Health Savings Accounts (HSAs): Professor Bloink argues that the combination of HDHPs and HSAs empowers employees by giving them more control over their healthcare spending. This model encourages employees to make smarter healthcare decisions due to the high out-of-pocket expenses, potentially leading to long-term savings. Furthermore, Bloink highlights that the ability to accumulate health savings balances allows individuals to prepare for future significant healthcare expenses, taking advantage of tax benefits during years with lower health costs.

2. Challenges and Misconceptions about HDHPs: Professor Byrnes counters by emphasizing the financial burden HDHPs place on employees, particularly those who do not or cannot maximize their HSA contributions. This leads to higher out-of-pocket expenses without the corresponding tax savings. Byrnes also points out the practical difficulties employees face in making informed healthcare decisions, as many lack the necessary knowledge to effectively "shop around" for better prices, potentially leading to increased long-term costs.

3. Economic Impact on Employers and Employee Segmentation: Byrnes further critiques the economic effectiveness of HDHPs for employers, noting that typically, healthier and higher-income employees opt for HDHPs, while those with higher medical costs prefer plans with lower deductibles. This segmentation suggests that while HDHPs may offer benefits for some, they do not universally provide current cost savings for employers or cater effectively to all employee demographics.

Can Intensive Lifestyle Changes Slow or Reverse Early Alzheimer's Disease?

By Kathrin LaFaver, MD and Dean Ornish, MD - Kathrin LaFaver, MD: I have the great pleasure today of talking to Dr Dean Ornish, a pioneer in the field of lifestyle medicine. He has many accolades to his name and is well known for bringing lifestyle medicine approaches to cardiovascular disease. But the reason we're talking today is the recently published study in Alzheimer's Research & Therapy on intensive lifestyle interventions for mild cognitive impairment and early AD. So, welcome, Dr Ornish. Read Full Article…

HVBA Article Summary

1. Study Background and Design: Dr. Dean Ornish described the genesis of his latest study, drawing a parallel between early-stage Alzheimer's disease (AD) and coronary heart disease. The study employed a holistic lifestyle intervention, integrating a whole-foods, plant-based diet, moderate exercise, stress-management techniques, and social support to address mild cognitive impairment and early-stage AD. This approach builds on Dr. Ornish’s decades of research suggesting that comprehensive lifestyle changes can significantly impact various chronic diseases.

2. Key Findings from the Study: The research demonstrated that after 20 weeks, patients undergoing the lifestyle interventions showed significant improvements in cognitive function without the use of drugs. This is notable against the backdrop of current AD treatments, which mainly slow disease progression with significant side effects and costs. Dr. Ornish emphasized the dual benefit of lifestyle changes—improving patient outcomes while providing a sense of hope, contrasting with the despair often associated with AD diagnosis.

3. Future Directions and Implications: Dr. Ornish plans to continue observing the study participants, highlighting the importance of long-term data in understanding the full impact of lifestyle interventions on AD. He also discussed broader applications of the study's findings, advocating for a shift towards more accessible and sustainable health interventions that can be implemented immediately by individuals without waiting for medical advancements.