Senate Appropriations adds ERISA preemption section to spending bill

By Allison Bell - Members of the Senate Appropriations Committee voted Thursday to add a slap at the Employee Retirement Income Security Act section that preempts state employee benefits laws to a spending bill. Read Full Article…

HVBA Article Summary

1. Amendment Overview: Senator Joe Manchin introduced an amendment to the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2025, focusing on the scope of ERISA preemption concerning dental and vision plans. This amendment seeks to clarify that ERISA's preemption of state laws should not shield abusive practices such as price fixing and steering enrollees towards plan-owned products and services, especially in stand-alone vision and dental insurance plans.

2. Legislative Context and Funding: The appropriations bill proposes $231 billion to support various federal agencies including those managing HealthCare.gov, pandemic responses, and employer-sponsored benefit plans. An increase in funding from $191 million to $206 million for the Employee Benefits Security Administration is highlighted, indicating a reinforced commitment to overseeing health and retirement plans amidst these legislative changes.

3. Potential Impact and Future Steps: This amendment signals growing scrutiny and potential rollback of ERISA preemption in specific areas, reflecting broader efforts to enable state-level regulation of certain insurance practices. The amendment requires a briefing on any reported state law violations within 90 days of enactment, marking a proactive approach to monitoring its implications. The bill, including this amendment, awaits full House approval and potential Senate revision, where Senator Manchin's influence as a swing voter might play a crucial role in maintaining the integrity of this amendment in the final legislation.

Medicare finalizes higher 2.9% inpatient payment rate for 2025

By Rebecca Pifer - The nearly 3,000-page final rule finalizes a 3.4% increase to the market basket, a metric that accounts for changes in the prices of hospital goods and services, reduced by a 0.5% productivity adjustment. Read Full Article…

HVBA Article Summary

1. Medicare Payment Increase and Distribution: The Biden administration has announced a finalized 2.9% payment increase for inpatient hospitals under Medicare for the upcoming year, a slight rise from the initially proposed 2.6%. This adjustment is set to channel an additional $2.9 billion to hospitals in 2025, marking it as one of the higher historical rate increases. Differentiation in rate adjustments will see for-profit operators receiving a 3.3% bump, while nonprofit hospitals are slated for a 2.7% increase.

2. Industry Reactions and Criticisms: Despite the increase, hospital lobbies have expressed dissatisfaction, arguing the rate remains inadequate. Criticism also extends to the finalized regulation’s other aspects, particularly those reducing payments to hospitals that serve more vulnerable populations and patients requiring long-term care. Such policy decisions have sparked concerns about exacerbating financial strains, with industry leaders highlighting the challenges of maintaining operations amidst high inflation and underestimated care costs.

3. New Policy Introductions and Implications: Alongside payment adjustments, the final rule introduces significant policy changes including the Transforming Episode Accountability Model, a mandatory payment model for certain surgical procedures set to start in 2026. Hospitals are wary of the model's compulsory nature and its potential financial impact on lower-resourced facilities. Additionally, adjustments in payment structures to better support the treatment of homeless patients and enhancements in technology payments for gene therapy access reflect broader efforts to address complex health and social needs.

How To Realize The Promise Of A Value-Based Care Future

By David B. Snow Jr. - Healthcare reform has been on Americans' minds for decades—especially as healthcare costs outpace average incomes, and the burden of paying for care falls on U.S. employers and consumers. Read Full Article…

HVBA Article Summary

1. Progress in Value-Based Care (VBC): The transition from a fee-for-service model, which prioritizes quantity over quality, to a value-based care model is underway. With nearly 60% of payments in 2022 linked to quality and value, healthcare stakeholders are increasingly leveraging analytics, care management technologies, and preventive care approaches. This shift aims to improve overall health outcomes and reduce costs by focusing on prevention and effective management of population health.

2. Challenges in Transitioning to VBC: Despite the progress, significant challenges remain. In 2022, 40% of payments were still based entirely on the fee-for-service model, which does not incentivize quality or value. The technological landscape in healthcare, often characterized by fragmented systems and outdated software, further complicates the transition. Employers and other key stakeholders also struggle to fully grasp their roles in supporting and benefiting from value-based care initiatives.

3. Future Directions for a Better Healthcare System: The article outlines a vision for a healthcare system empowered by advanced technology, integrated data management, and patient-centered care. Emphasizing the role of generative AI and other technological advancements, it suggests that these tools can enable more personalized care, predictive healthcare management, and effective collaborative approaches. The future success of value-based care will depend on seamless data integration, comprehensive care models, and strategic partnerships that align incentives with health outcomes.

Climate change is already worsening employee health. Are employers prepared?

By Deanna Cuadra - Between record-breaking summer temperatures and the increase in natural disasters, climate change is more visible than ever before. But what some employers may not see is the toll climate change has already taken on employee health. Read Full Article…

HVBA Article Summary

1. Financial Impact of Climate-Related Health Issues: Recent research indicates that climate change-related health conditions, fueled by air pollution from fossil fuels, lead to approximately $820 billion in annual healthcare costs. These costs are associated with a range of conditions, including respiratory and heart diseases, food and pest-related illnesses, and injuries from natural disasters like floods and wildfires. The study underscores the urgent need for integrated strategies that address environmental sustainability within the healthcare sector to mitigate these substantial costs.

2. Healthcare Recommendations for Employers: Baylis Beard of Blue Shield of California highlights the immediate health impacts of climate change, such as asthma, premature labor due to high heat, and access disruptions during natural disasters. Employers are advised to conduct materiality assessments to understand and address the environmental risks faced by employees both at home and in the workplace. These assessments can guide the development of health plans and policies that not only reduce these risks but also enhance overall employee well-being.

3. Inclusive and Sustainable Workplace Strategies: Beard emphasizes the importance of considering the environmental threats in both employees’ communities and workplaces, noting the disproportionate impact of climate change on communities of color. Strategies to combat these disparities include providing air filters, remote work policies during extreme weather, and expanding access to telehealth services. Employers are also encouraged to involve employees in local sustainability efforts, such as tree planting and community gardening, to bolster community resilience against climate change.

Trending: Billion-Dollar Investments Drive AI Surge in Healthcare

By PYMNTS - The healthcare industry is witnessing a shift as artificial intelligence (AI) attracts massive investments and partnerships. Spring Health’s $3.3 billion valuation, CytoReason’s $80 million funding round, and the AWS-GE HealthCare collaboration highlight the growing confidence in AI’s potential to transform mental health services, accelerate drug discovery, and revolutionize patient care delivery. Read Full Article…

HVBA Article Summary

1. Series E Success for Spring Health: Spring Health, a New York-based mental health platform, successfully raised $100 million in a Series E funding round led by Generation Investment Management, boosting its valuation to $3.3 billion. The platform, co-founded by April Koh and Adam Chekroud in 2016, employs AI to personalize patient care by matching them with suitable providers and treatment plans, demonstrating a robust growth trajectory in the digital mental health space.

2. CytoReason's Strategic Funding for AI in Pharma: CytoReason, a startup founded in 2016, has garnered $80 million to enhance its AI-driven platform for disease modeling and drug discovery. With significant investments from industry giants like Nvidia and Pfizer, the company aims to revolutionize pharma research by creating computational disease models that accelerate the development of new therapeutics. This investment reflects the growing recognition of AI's potential in transforming pharmaceutical research and development.

3. Collaborative Innovation by AWS and GE HealthCare: AWS and GE HealthCare have initiated a partnership to integrate AI technologies to enhance patient care. This collaboration will focus on developing AI models and applications to unlock the massive, often inaccessible, healthcare data, aiming to improve patient outcomes, enhance operational efficiency, and promote personalized care. Leveraging AWS’ advanced machine learning capabilities and GE HealthCare's industry expertise, this initiative marks a significant step towards innovating healthcare practices globally.

Up and Up: Towns and Schools Face Double Digit Health Insurance Increases in New Jersey

By Jeanne Wall - Taxpayers will be asked to buckle up yet again as health insurance costs continue to rise in New Jersey towns and schools. Area towns, such as Hazlet, use SHBP for their employee medical coverage. Its set to go up over 17%. Read Full Article…

HVBA Article Summary

1. Rising Healthcare Costs and Plan Sustainability: The State Health Benefits Program (SHBP) is facing significant financial pressures due to increased claims and the departure of lower-risk entities such as towns and schools with minimal claims. This exodus threatens the sustainability of the plans, as it may lead to a concentration of high-risk participants, escalating the overall costs and potentially leading to a cycle of ever-increasing premiums.

2. Public Sector Responses to Cost Increases: In response to mounting healthcare costs and dissatisfaction with rate increases, public sector leaders, including elected officials and administrators from various school districts and municipalities, are actively exploring alternative insurance options. They are conducting due diligence to assess the viability of exiting the SHBP to find more cost-effective solutions, highlighting a growing trend of public entities taking proactive steps to manage their healthcare expenses.

3. SHBP's Strategic Adjustments for 2025: The SHBP Plan Design Committee has adopted several resolutions aimed at curbing these cost trends, including the introduction of innovative programs like the Centers of Excellence (COE) Pilot Program. This program focuses on bundled pricing and transparent costs for specific non-emergent procedures, offering incentives like copayment exemptions and gift cards to encourage participation, which is designed to improve clinical outcomes and control spending.

The Skinny on What We Know About the Microbiome and Obesity

By Carolyn Christ - As human microbiome studies proliferate, scientists are uncovering ways in which it can influence inflammation, chronic diseases, and even obesity. These findings are leading to promising clinical applications, such as the successful use of fecal microbiota transplantation (FMT) in treating Clostridioides difficile infection (CDI). However, there's so much more to learn, said Sahil Khanna, MBBS, MS, a professor of medicine and gastroenterologist at Mayo Clinic. Read Full Article…

HVBA Article Summary

1. Exploring the Microbiome-Obesity Connection: Dr. Khanna highlights the burgeoning interest in the gut microbiome's role in obesity management at the Obesity Medicine 2024 conference. His work at the Mayo Clinic involves the use of Fecal Microbiota Transplantation (FMT) for Clostridioides difficile infections (CDI) and extending this research to explore potential treatments for obesity. This approach is driven by evidence suggesting that microbiome imbalances might be pivotal in diagnosing and treating metabolic disorders, which are on the rise globally.

2. The Science and the Promise: Recent research, according to Khanna, points towards specific bacterial groups that could be targeted to enhance metabolic processes, suggesting a nuanced approach to FMT. Beyond just transplanting microbiota, he discusses integrating lifestyle changes, medications, and potentially surgical interventions to comprehensively address obesity. This integrated treatment model reflects a shift from isolated interventions to a holistic strategy aimed at modifying the gut microbiome to influence obesity.

3. Challenges and Future Directions: While the research is promising, Khanna notes several challenges, such as the complexity of the gut-brain axis and its role in obesity. He emphasizes the need for continued research to unravel how microbiome alterations can affect appetite regulation and metabolic functions. Furthermore, he addresses common misconceptions about microbiome testing and the current limitations of translating this research into clinical practice, underscoring the importance of robust clinical trials to validate the efficacy of microbiome-based therapies for obesity.

Healthcare workers see higher educational, medical debt: report

By Mari Devereaux - Extensive training requirements and lower wages lead healthcare professionals to accrue more debt than other workers, according to a recent analysis published in JAMA Health Forum. Read Full Article…

HVBA Article Summary

1. Prevalence of Debt Among Healthcare Workers: The study highlights that healthcare workers, including physicians and nurses, are more likely to have educational debt compared to other industries. For instance, 27% of healthcare professionals have student loan debt, significantly higher than the 17% in other fields. Moreover, medical debt is particularly high among lower-paid staff such as nursing aides and environmental service workers.

2. Disproportionate Impact on Specific Groups: Medical and educational debts disproportionately affect certain demographics within the healthcare workforce. Notably, nearly one in five nursing aides and assistants, who are often women and belong to minority groups like Black and Latino individuals, are burdened with medical debt. Similarly, Black clinicians are found to have a higher incidence of educational debt compared to their white counterparts, influenced by socioeconomic factors and limited access to loan forgiveness programs.

3. Consequences of Debt on Well-being and Professional Choices: The burden of debt among healthcare workers not only affects their financial stability but also their mental health and physical well-being. High levels of debt may deter these workers from seeking necessary medical care and influence their professional decisions, such as accepting certain roles within the industry. The article suggests that health system leaders need to consider these factors seriously when setting salaries and designing benefits packages to avoid exacerbating the debt situation among their employees.

Intermittent Fasting May Improve Memory, Executive Function, Early Trial Suggests

By Judy George - Intermittent calorie restriction improved executive function and memory measures in cognitively intact older adults, an exploratory pilot study suggested. The 8-week randomized clinical trial of 40 overweight, cognitively normal older adults with insulin resistance examined the effect of two interventions -- a 5:2 intermittent fasting plan versus a "healthy living" diet based on portion control and calorie reduction guidelines from the U.S. Department of Agriculture -- on brain health. Read Full Article…

HVBA Article Summary

1. Study Design and Participant Details: Dimitrios Kapogiannis, MD, led a study examining the effects of intermittent fasting (5:2 diet) versus a healthy living diet on adults aged 55 to 70. Participants included 40 older adults with an average BMI of 34.4, who were split into two groups: 20 followed the intermittent fasting regime and 20 adhered to a healthy living diet. The study, conducted from 2015 to 2022 at the National Institute on Aging Clinical Research Unit, focused on cognitive performance, brain metabolism, and Alzheimer’s-associated biomarkers.

2. Interventions and Outcomes: The intermittent fasting group consumed two meal replacement shakes totaling 480 calories on two days per week, while enjoying a healthy living diet on the other five days. Both diets resulted in improved brain glucose metabolism, reduced BrainAGE, and decreased body mass index and waist circumference. Notably, intermittent fasting led to better improvements in certain cognitive measures like executive function and memory when compared to the healthy living diet.

3. Insights and Future Research Directions: Despite the short trial duration of 8 weeks, the study provided promising evidence linking diet to cognitive health and brain aging. Kapogiannis highlighted the need for larger clinical trials to explore a variety of dietary interventions aimed at enhancing brain health and longevity. The findings, published in Cell Metabolism and presented at the Alzheimer's Association International Conference, underscore the potential of dietary approaches in mitigating age-related cognitive decline.