Addressing Medical Debt Is Important. Addressing Its Root Causes Is Just As Essential.

By Wendell Potter - The huge and growing burden of medical debt undoubtedly will be a presidential campaign issue and one that Vice President Harris will highlight. It will be interesting to see what former President Trump will say about it. Read Full Article…

HVBA Article Summary

1. Implementing Comprehensive Caps on Out-of-Pocket Costs: To tackle the root causes of medical debt, it’s crucial to establish stringent annual caps on out-of-pocket expenses. The current limits under the Affordable Care Act, at $9,450 for individuals and $18,900 for families, are prohibitively high. A more feasible approach would be to introduce a $2,000 cap on prescription drug costs and a $5,000 overall cap for out-of-pocket expenses, particularly for those enrolled in Affordable Care Act marketplace plans. This could significantly alleviate the financial strain on families, preventing them from falling into debt or losing their homes due to medical expenses.

2. Addressing High-Deductible Health Plans: The shift towards high-deductible health plans over the past 20 years has exacerbated the issue of medical debt. These plans, which were marketed as "consumer-driven," have led to significantly higher out-of-pocket costs for many Americans, despite having health insurance. Reassessing and revising the structure of these plans to include lower deductibles and more manageable out-of-pocket costs is essential to reducing the financial burden on individuals and families.

3. Advocating for Policy Changes and Political Support: It's imperative for political leaders to not only address the symptoms of medical debt but also confront its underlying causes. Advocating for policy changes such as the removal of medical debt from credit reports, as proposed by the White House, and supporting legislation that caps out-of-pocket costs are crucial steps. Mobilizing support from both sides of the political spectrum and holding candidates accountable for their stance on these issues can drive meaningful reforms and provide relief to millions of Americans struggling with medical debt.

Nearly half of insured Americans get surprise expenses in medical bills, survey finds.

By Ken Alltucker - Nearly half of Americans with health insurance said they received a recent medical bill or a charge that "should have been free or covered by their insurance," according to a survey released Thursday. Read Full Article…

HVBA Article Summary

1. High Incidence of Billing Errors and Low Dispute Rates: According to a survey by the Commonwealth Fund, 45% of working-age consumers received erroneous medical bills last year, but less than half of those affected challenged these unexpected charges. This lack of disputes may stem from a lack of awareness among consumers about their rights or the procedures to contest these bills.

2. Benefits of Contesting Surprise Bills: The survey highlighted that among the consumers who did contest their surprise medical bills, over one-third found it beneficial, with the disputed charges being reduced or completely waived. This underscores the potential financial relief that can be achieved by challenging incorrect billing.

3. Systemic Issues in Health Insurance: The survey exposes fundamental flaws in the health insurance system, where coverage complexities and a lack of transparency lead to frequent unexpected bills and denials of coverage. Sara Collins of the Commonwealth Fund pointed out that many consumers are unclear about what their plans cover, which services will be billed, and the overall lack of clarity from insurance officials, contributing to reduced trust in the system's ability to provide affordable and timely care.

Promising New Data Support GLP-1s for Dementia Prevention

By Megan Brooks - A new study supports the potential to repurpose glucagon-like peptide 1 (GLP-1) receptor agonists, used to treat type 2 diabetes and obesity, for dementia prevention. Read Full Article…

HVBA Article Summary

1. Neuroprotective Effects of Liraglutide: In the phase 2b ELAD clinical trial, adults with early-stage Alzheimer's disease who received daily subcutaneous injections of the GLP-1 receptor agonist liraglutide showed significant benefits compared to those receiving a placebo. Over a 12-month period, the liraglutide group experienced an 18% slower decline in cognitive function and nearly 50% less brain volume loss in critical areas related to memory and decision-making. These results suggest that liraglutide may have a protective effect on the brain, akin to how statins protect the heart.

2. Potential Mechanisms and Safety: According to Paul Edison, MD, PhD, the study chief from Imperial College London, liraglutide may offer multiple protective mechanisms against Alzheimer's disease, including reducing inflammation, lowering insulin resistance, and mitigating the toxic effects of Alzheimer's biomarkers like amyloid-beta and tau. The treatment was also noted to be well-tolerated among participants, with fewer serious side effects in the liraglutide group compared to the placebo group.

3. Implications and Future Research: Despite the promising outcomes observed, the study's primary endpoint—change in the cerebral glucose metabolic rate—was not met, indicating the need for further research. Experts like Howard Fillit, MD, and Heather Snyder, PhD, emphasize the necessity of larger phase 3 trials to validate these findings and fully assess the therapeutic potential of liraglutide in Alzheimer's disease. The ongoing phase 3 EVOKE trial, which is investigating semaglutide, another GLP-1 receptor agonist, highlights the growing interest in this class of drugs for neurodegenerative diseases.

Americans' trust in doctors, hospitals plunged during pandemic, survey suggests

By Mary Van Beusekom, MS - Trust in US physicians and hospitals fell from 71% to 40% during the COVID-19 pandemic in across sociodemographic groups, a Massachusetts General Hospital (MGH)–led survey study suggests. Read Full Article…

HVBA Article Summary

1. Decline in Trust and Vaccination Rates: The study observed a significant decline in trust towards physicians and hospitals among the US population, plummeting from 71.5% to 40.1% during the study period. This erosion of trust was associated with lower likelihoods of COVID-19 vaccination and booster uptake across various socioeconomic groups, highlighting the impact of decreased trust on public health outcomes.

2. Factors Influencing Trust: Regression analysis revealed that lower trust levels were more prevalent among adults aged 25 to 64, women, individuals with lower educational attainment and income, Blacks, and urban residents, even when accounting for political affiliations. This nuanced understanding of trust dynamics suggests targeted areas for intervention to enhance trust and improve health outcomes.

3. Implications for Public Health Interventions: The study emphasizes the need for effective interventions to rebuild trust, not only to counter the effects of the COVID-19 pandemic but also to strengthen the overall health infrastructure in the U.S. Despite challenges, as noted in prior reviews showing modest effects of trust-enhancing interventions, the findings underscore the potential long-term public health benefits of restoring trust in the healthcare system.

Teladoc withdraws 2024 outlook, logs impairment charge amid downturn at BetterHelp

By Emily Olsen - The financial results, which beat Wall Street expectations on earnings per share but missed on revenue, marked Teladoc’s first earnings report since former insurance executive Divita took the reins at the telehealth vendor in June. Read Full Article…

HVBA Article Summary

1. Financial Struggles and Strategic Reassessment: Teladoc Health has pulled back its financial forecast for the entire year of 2024, following a significant increase in net losses, which surged to $837.7 million in Q2 from a previous $65.2 million in the same period last year. This loss includes a substantial $790 million goodwill impairment charge due to declining performance in its direct-to-consumer mental health service, BetterHelp. In response, Teladoc is now reevaluating its strategic direction and operational structure under the leadership of the newly appointed CEO, Chuck Divita.

2. Leadership and Operational Changes: Amid these financial challenges, Teladoc has undergone notable leadership changes with Jason Gorevic, CEO since 2009, stepping down in April. The company has initiated an operational review aimed at boosting profitability, which has so far yielded mixed results, particularly highlighted by the underperformance of BetterHelp. This segment not only experienced a significant drop in paying users and revenue but also faced rising advertising costs.

3. Future Plans and Growth Areas: Despite setbacks in its mental health segment, Teladoc is exploring new strategies for improvement, such as expanding BetterHelp internationally, particularly in non-English speaking markets, and integrating insurance coverage to enhance service affordability in the U.S. Meanwhile, Teladoc's integrated care division showed positive growth, with an 8% increase in membership and a significant rise in adjusted EBITDA, indicating potential areas of strength amidst broader company challenges.

As GLP-1 Demand Goes Up, Access and Coverage Go Down

By Nancy A. Melville - Experts debating the pressing issue of how to prioritize patients in the increasingly common scenario of loss of access or insurance coverage for anti-obesity glucagon-like peptide 1 (GLP-1) receptor agonist drugs argued that comorbidities and obesity severity should strongly warrant continued coverage — while offering key strategies for getting and retaining approval from payers. Read Full Article…

HVBA Article Summary

1. Inequitable Access Amidst Rising Demand: Deborah Horn highlighted a significant paradox in healthcare at the ADA's 84th Scientific Sessions—despite growing demand for GLP-1 medications for weight loss, restrictive health policies are limiting access. For example, her health system notifies patients that reaching a BMI of 30 disqualifies them from receiving GLP-1 medications under their health plan, even though discontinuation leads to rapid weight regain and loss of cardio-metabolic benefits. This is a common practice in various U.S. health systems, including the Mayo Clinic, which forces clinicians and patients to seek less effective alternatives.

2. Focusing on Broader Health Benefits: Pam R. Taub argued that insurers should prioritize coverage based on the cardiovascular benefits of GLP-1 medications rather than solely on weight loss. By emphasizing the prevention of major cardiovascular events—which are cost-intensive for insurers—Taub suggests that coverage decisions should support ongoing GLP-1 treatment for patients, especially those with comorbidities like type 2 diabetes and peripheral artery disease, which are closely linked to cardiovascular health.

3. Prioritizing High-Risk Patients and Addressing Cost Concerns: Neda Rasouli and William H. Herman addressed the need to prioritize GLP-1 treatments for high-risk obesity patients and questioned the high costs associated with these drugs. Rasouli emphasized the urgency of treating severe obesity with the same intensity as smoking cessation, given its high risk and potential life expectancy loss. Herman criticized the pricing strategies of pharmaceutical companies, pointing out that the high costs of GLP-1s are unjustifiable given that the initial R&D was already conducted for diabetes, suggesting a need for pricing reforms to enhance access and equity.

Why Many Nonprofit (Wink, Wink) Hospitals Are Rolling in Money

By Elisabeth Rosenthal - One owns a for-profit insurer, a venture capital company, and for-profit hospitals in Italy and Kazakhstan; it has just acquired its fourth for-profit hospital in Ireland. Another owns one of the largest for-profit hospitals in London, is partnering to build a massive training facility for a professional basketball team, and has launched and financed 80 for-profit start-ups. Another partners with a wellness spa where rooms cost $4,000 a night and co-invests with “leading private equity firms.” Do these sound like charities? Read Full Article…

HVBA Article Summary

1. Blurred Lines Between Nonprofit and For-Profit Activities: Many of the largest nonprofit hospital systems in the U.S. engage in for-profit ventures while maintaining their tax-exempt status. This allows them to reap financial benefits such as tax breaks and preferential bond rates, despite owning for-profit businesses like parking lots and laundry services. Critics, including economics professor Martin Gaynor, argue that these hospitals operate more like big businesses than charitable organizations, leveraging legal and regulatory loopholes to maximize profits under the guise of nonprofit status.

2. Evolving Hospital Revenue Streams and IRS Oversight: As medical care has become more effective and insurance coverage more widespread, nonprofit hospitals have increasingly merged and acquired for-profit entities, diversifying their income streams significantly. Despite their hefty earnings, these hospitals categorize surplus revenues as "operating surpluses" rather than profits. Meanwhile, the IRS and other regulatory bodies have been criticized for their lax oversight, allowing these hospitals to stretch the definition of “community benefit” in ways that may not directly align with traditional charitable healthcare missions.

3. Calls for Reform Amid Growing Scrutiny: The expanding wealth and influence of nonprofit hospitals have led to scrutiny over their community benefits and executive compensation, with some CEOs receiving salaries in the millions. Recent lawsuits and reports suggest a need for stricter enforcement and clearer guidelines on what constitutes sufficient community benefit. Critics like Michael West advocate for an end to the "community benefit charade" and suggest that these hospitals should contribute more to public coffers, reflecting a shift toward accountability and transparency in hospital system operations.

What drives health spending in the U.S. compared to other countries?

By Emma Wager, Shameek Rakshit, and Cynthia Cox - The United States spends significantly more on healthcare than comparable countries do, and yet has worse health outcomes. Much of the national conversation has focused on spending on retail prescription drugs and insurer profits and administrative costs as key drivers of health spending in the United States. Read Full Article…

HVBA Article Summary

1. High Health Spending in the U.S. Compared to Peers: The United States spends nearly twice as much on healthcare per capita as other wealthy OECD nations, with a significant portion of this expenditure going toward inpatient and outpatient care. While the U.S. allocates $12,197 per person, comparable countries spend an average of $6,514. The primary cost drivers in the U.S. are payments to hospitals and physicians, which are significantly higher than those in peer countries, illustrating a systemic issue in healthcare pricing and management.

2. Administrative Costs and Prescription Drug Prices: Administrative costs in the U.S. are also notably higher than in peer nations, at $925 per capita compared to $245. Additionally, the U.S. spends more on prescription drugs, with a per capita expenditure of $1,635, which contrasts sharply with the $944 average in comparable countries. Despite legislative efforts like the Inflation Reduction Act aiming to lower these costs, the impact on overall health spending is minimal due to the dominance of provider payments in total expenditures.

3. Disparities in Care and Health Outcomes: Despite higher spending, the U.S. does not exhibit better health outcomes or higher utilization rates of healthcare services. In fact, Americans have less access to medical care, including fewer physician visits and longer wait times for appointments. The U.S. also has fewer physicians per capita compared to its peers, compounding accessibility issues. This suggests that increased spending is not translating into proportional improvements in patient care or health system efficiency.

Is Your Sedentary Lifestyle Killing You? New Study Says Yes

By Vinod Rane - A less favorable balance between physical activity (PA) and sitting time (ST) is associated with a higher risk for all-cause mortality. Read Full Article…

HVBA Article Summary

1. Study Design and Population: Researchers conducted a longitudinal study involving 5,836 middle-aged and older adults from the Australian Diabetes, Obesity and Lifestyle Study. The participants, with a mean age of 56.4 years and comprising 45% men, were monitored to evaluate the association between physical activity (PA) and sitting time (ST) with the risk of all-cause mortality. The novel Physical Activity and Sitting Time Balance Index (PASTBI) was utilized, dividing total daily PA by daily ST, to categorize participants into quartiles from low PA/high ST to high PA/low ST.

2. Findings and Mortality Risk: Over a median follow-up period of 14.3 years, 885 (15%) of the participants died due to various causes. The study highlighted a significant disparity in survival rates based on the PASTBI scores; participants in the lowest quartile (low PA/high ST) exhibited a 47% higher risk of all-cause mortality compared to those in the highest quartile (high PA/low ST), with an adjusted hazard ratio of 1.47 (95% CI, 1.21-1.79).

3. Implications and Utility of PASTBI: The results underscore the potential of the PASTBI as a practical tool for assessing mortality risks associated with physical inactivity and prolonged sitting times. This index helps in emphasizing the critical need for a balanced approach to physical activity and sitting habits to enhance longevity and reduce mortality risks. This is particularly relevant in guiding public health interventions and personal health behaviors to mitigate risks associated with sedentary lifestyles.