'A great step forward': Nearly 9 million Americans to benefit from Medicare drug price cuts

By Kerry Hannon - Ask Teresa Smith how she feels about the hefty healthcare bills she and her husband pay each year, and her answer is simply: “Help!”Smith takes Farxiga, a daily medication to control her Type 2 diabetes, and her husband does too. Plus he takes the blood thinner Eliquis for a heart condition. Read Full Article…

HVBA Article Summary

1. Rising Healthcare Costs Impacting Seniors: Smith and her husband, retired and living primarily on Social Security and a small pension, face significant healthcare expenses with over $13,600 annually spent on Medicare Part D, Medigap, and out-of-pocket costs for prescriptions. This substantial financial burden highlights the broader issue affecting many seniors, where fixed incomes do not align with escalating healthcare expenses.

2. New CMS Negotiated Drug Prices: Relief is in sight for Medicare beneficiaries like the Smiths with the introduction of CMS's first-ever negotiated drug price list. This list significantly reduces the costs of essential medications by 38% to 79%, effective from January 2026. This reduction could alleviate the financial strain for millions, as the Smiths' necessary medications, Eliquis and Farxiga, are included in these price cuts.

3. Long-Term Savings and Immediate Relief Options: While the new drug prices offer a future prospect of lower expenses, immediate steps can be taken to manage costs. Beneficiaries are advised to review changes during the Medicare open enrollment period and consider plan adjustments that better meet their financial and medical needs. Additionally, programs like Medicare’s Extra Help and various discount options provide some relief ahead of the 2025 implementation of the new $2,000 cap on annual out-of-pocket costs for covered drugs.

Employers embracing direct contracting and bypassing insurers: survey

By Noah Tong - Employers are actively seeking out alternatives to curb rising health benefit costs by sidestepping traditional carriers, a new report from Brighton Health Plan Solutions shows. Read Full Article…

HVBA Article Summary

1. Growing Interest in Direct Contracting: According to a recent report, 75% of health benefit leaders are discussing direct contracting, with 41% of those not currently engaged considering it for 2025. This indicates a significant shift towards direct provider contracting as a preferred method over traditional partnerships with health insurers, driven by potential savings ranging from 6% to 20%.

2. Benefits of Direct Contracting: Nearly half of the respondents view direct contracting as a means to enhance benefits and reduce costs. This perspective underscores the appealing financial and operational efficiencies that direct contracting can offer to employers, particularly in a market where healthcare costs are continually rising.

3. Challenges and Opportunities for Provider Outreach: Despite the growing interest, only 39% of participants reported that providers have initiated discussions on direct contracting, which slightly increases to 47% for third-party administrators. This gap highlights a significant opportunity for health systems and providers to intensify their outreach efforts and engage more directly with potential clients, especially those already considering this approach.

CBO sees high ACA subsidies cutting group health enrollment

By Allison Bell - Analysts at the Congressional Budget Office believe that maintaining the current premium subsidy levels for individual health coverage could cut enrollment in employment-based coverage by about 3.5 million people, or 2% of total enrollment. Read Full Article…

HVBA Article Summary

1. Impact on Employer-Sponsored Coverage: The Congressional Budget Office (CBO) provided analysis indicating that maintaining the elevated subsidy levels for the premium tax credit, introduced post-COVID-19, could lead to a reduction in employment-based health insurance coverage. This effect is particularly noted in smaller, newly established companies where the availability of subsidized marketplace coverage diminishes employers' incentives to offer private health insurance.

2. Budgetary Implications: The CBO estimates that making the current levels of premium tax credit subsidies permanent would increase the federal budget deficit by $335 billion over a decade, from 2025 to 2035. This calculation is based on the assumption that an additional 6.9 million people would utilize these subsidies, costing an average of approximately $4,900 per person per year.

3. Factors Influencing Health Care Cost Trends: In response to inquiries from senators, the CBO cited slower-than-anticipated growth in overall healthcare costs. Key factors include less rapid increases in drug prices due to fewer new drug launches than expected and a decline in the use of facility-based care among Medicaid beneficiaries, along with a reduced need for long-term care services in the community.

Concierge medicine comes to college campuses

By Maya Goldman - The growing concierge medicine market has a new target demographic: college students and their anxious parents. Why it matters: It's the latest example of how expanded access to health care is available to those willing to pay, which critics say drives up costs without necessarily improving outcomes. Read Full Article…

HVBA Article Summary

1. Rising Popularity of Concierge Services on College Campuses: The introduction of concierge medicine services like College-Docs and UniversityMD on college campuses caters to the demands of concerned parents ensuring their children receive prompt and dedicated healthcare. This model provides students with services such as direct access to healthcare professionals, shorter wait times, and personalized care, which are not typically available through campus health clinics.

2. Benefits and Expansion of the Model: These concierge services are expanding rapidly, with plans to grow in more universities, suggesting a strong market potential and acceptance. The services not only promise to enhance the healthcare experience for students but also allow physicians to manage a healthier population with potentially more satisfying professional experiences. For example, UniversityMD serves five colleges with hopes to expand further, offering comprehensive care for a variety of health concerns at a fixed semester fee.

3. Concerns and Criticisms: Despite the advantages, there are significant criticisms concerning the impact of concierge medicine on overall healthcare equality and cost. Studies indicate that such services might not necessarily improve health outcomes but could lead to higher healthcare costs and exacerbate the shortage of primary care providers. Additionally, there's a concern about the potential over-involvement of parents in students' healthcare decisions, which might hinder the development of independence in young adults.

New Jersey cancels $100M in medical debt for almost 50,000 patients

By Lynn Cavanaugh - New Jersey Governor Phil Murphy announced on Wednesday that thousands of eligible individuals and families across the state will have some or all of their medical debt cancelled as part of a major initiative to make health care more affordable and accessible. The initiative comes as other states and federal regulators have moved to lessen the burden of medical debt. Read Full Article…

HVBA Article Summary

1. New Jersey's Debt Relief Initiative: In an effort similar to Connecticut's approach in February, New Jersey utilized $550,000 from the 2021 American Rescue Plan Act to provide medical debt relief. The state partnered with the non-profit organization Undue Medical Debt to absolve $61.6 million owed to Prime Healthcare hospitals by 17,905 residents and an additional $38.4 million owed by 31,748 residents through secondary debt markets. This action is part of a broader national movement aimed at reducing the burden of medical debt on Americans.

2. Legislative and Nationwide Efforts: The debt relief efforts in New Jersey are part of a larger trend that originated in Cook County, Illinois, with the assistance of RIP Medical Debt, a non-profit that purchases medical debt portfolios to forgive them. Following Illinois' lead, which recently passed laws to allocate $10 million towards purchasing medical debt, other local governments including cities in Ohio, Michigan, D.C., and New York have enacted similar initiatives. New York City notably erased $2 billion in medical debt for half a million patients earlier this year.

3. Political and Policy Context: Governor Phil Murphy emphasized the importance of focusing on recovery rather than financial burdens in medical emergencies. His remarks were supported by new policies under the Louisa Carman Medical Debt Relief Act, which provides protection from medical debt accumulation and predatory collections. This law, alongside the state's initiative to eliminate medical debt reporting to credit agencies, aims to create systemic changes to ensure long-term relief and health care affordability for New Jerseyans.

Three Things That Employer Health Plan Sponsors Should Do When the New MHPAEA Rules Are Published

By Cassandra Labels and David Shillcutt - The U.S. Departments of Labor (DOL), Health and Human Services, and the Treasury (collectively, the “Tri-Departments”) published a Notice of Proposed Rulemaking (NPRM) on August 3, 2023, to propose new regulations for the Mental Health Parity and Addiction Equity Act (MHPAEA). Read Full Article…

HVBA Article Summary

1. Enhanced Service Agreements and Coordination: Health plans are advised to review and update their service agreements with all delegated service providers to ensure that these agreements clearly define obligations related to MHPAEA compliance. This includes the development and regular updating of comparative analyses for Non-Quantitative Treatment Limits (NQTLs) and supporting data needs during regulatory investigations. Plans that involve multiple vendors may need coordinated efforts to create comprehensive NQTL analyses.

2. Development of a Comprehensive Work Plan: Employer health plans should create a detailed work plan to update their MHPAEA compliance documentation. This plan should address the new requirements for NQTLs introduced by the CAA, ensuring all existing documentation aligns with the upcoming regulations. This includes preparing for new quantitative tests for NQTLs, assessing the adequacy of existing NQTLs, and revising any that do not meet the new standards. The work plan should also outline responsibilities and timelines for both the health plan and its service providers.

3. Fiduciary Review and Certification Process: The new rules are expected to mandate that at least one named fiduciary per plan reviews each comparative analysis of NQTLs and certifies compliance with the new content requirements. Plans must identify and confirm the qualifications of these fiduciaries, who may need to seek expert legal counsel to navigate the complexities of MHPAEA requirements and ensure the sufficiency of the comparative analyses. Establishing a fiduciary committee, similar to those used for retirement plans, might be considered by employers to handle these responsibilities effectively.

Benefits Think What's in and what's out for benefits in 2025

By Ellen Rudolph - With new companies and diverse benefits flooding the employer market, it's fair to say that benefits leaders are being overwhelmed by the number of point solutions available to help their employees improve their health and well-being. Employee benefits leaders are inundated with cold emails from vendors and it can be challenging to sort through all of the noise. The reality is that it's not feasible for every point solution to rise to the top of an employer's priority list. Read Full Article…

HVBA Article Summary

1. Shifting from PEPM to Performance-Based Pricing: Employers are moving away from the traditional Per Employer Per Month (PEPM) pricing models, which often lack transparency and accountability for actual value delivered. Instead, they are favoring pricing guarantees that directly align costs with the outcomes and savings generated by digital health solutions. This shift is driven by a desire to consolidate offerings and ensure each benefit clearly demonstrates its return on investment, reflecting a larger trend towards greater scrutiny of benefits in response to economic pressures.

2. Increasing Recognition of Invisible Illnesses: Post-pandemic, there's a notable shift in employer benefits toward recognizing and addressing invisible illnesses, such as Long COVID, autoimmune diseases, and mental health conditions. Historically underreported due to stigma, these conditions are now being acknowledged for their significant impact on both direct healthcare costs and workplace productivity (absenteeism and presenteeism). Employers are implementing more inclusive health benefits and workplace policies to support these employees, helping to reduce indirect costs and improve overall employee well-being.

3. Embracing Whole Person Care Over Fragmented Care: Employers are increasingly advocating for whole person care approaches that view the patient holistically rather than through the fragmented lens of specific symptoms or conditions. This integrated care model is becoming more popular as it aims to improve clinical outcomes and reduce healthcare spending by minimizing unnecessary specialist visits and treatments. Whole person care emphasizes understanding the interconnected nature of various health issues, promoting a comprehensive approach to employee health that encompasses both physical and mental well-being.

How Congress members get their health insurance

By Rylee Wilson - Members of Congress are tasked with making decisions about the future of the ACA exchange — and they also receive their healthcare benefits through it. Read Full Article…

HVBA Article Summary

1. Shift in Insurance Framework for Congress: Before 2014, members of Congress and their staff were covered under the Federal Employee Health Benefits Program, but a provision of the Affordable Care Act now mandates that they obtain their health insurance through DC Health Link, aligning their experiences with those of other American citizens who utilize the exchange markets for health coverage.

2. Medicare Eligibility and Enrollment Practices: As of 2023, a significant portion of Congress—34% of senators and about 16% of representatives—are over 70 years old and qualify for Medicare. According to Dr. Jack Hoadley, most individuals in such positions, despite being eligible for Medicare, usually only enroll in Medicare Part A, which covers inpatient hospital services without a premium, while continuing to receive employer-based coverage.

3. Comparative Analysis of Premium Contributions: While the federal government subsidizes 72% to 75% of the premium costs for members of Congress, similar to the support provided in the Federal Employee Health Benefits Program, this figure contrasts with the private sector where employees generally cover about 22% of their own premium costs. This structure places congressional members' benefits in line with broader national standards, offering them a practical understanding of the health insurance landscape experienced by their constituents.

5 communication best practices for enhancing client retention

By Ayo Mseka - When it comes to retaining clients, regular client communication can prove an asset. But communication without value for the client can be a hinderance rather than a help. What are best practices for client communication? Read Full Article…

HVBA Article Summary

1. Importance of Communication Frequency and Quality: The survey emphasizes that frequent and quality communication significantly boosts client confidence, especially in turbulent economic times. Clients who are contacted regularly show a higher comfort level (71%) with their financial plan if a recession were to occur, compared to just 22% for those who receive infrequent communication.

2. Client Preferences and Understanding: There is a notable preference for personalized and frequent contact among clients with substantial assets. About 47% of clients with over $500,000 under advisory desire monthly interactions. However, the survey also notes a decline in the comprehension of communications since the last survey, indicating a need for clearer and more engaging discussions.

3. Strategic Communication and Personalization: The survey suggests adopting varied communication strategies to cater to different client needs and preferences, such as using podcasts or blogs to cover relevant topics. Additionally, it introduces the concept of providing "champagne or sparkling water" service levels to differentiate the frequency and depth of communication based on the client's investment size and engagement, which could enhance client satisfaction and loyalty.