The Biggest Healthcare Trends Of The Next 10 Years

By Bernard Marr - Although my work usually involves advising businesses on changes and trends that are just around the corner, sometimes it’s also interesting to look a little further ahead. If, as Harold Wilson said, a week is a long time in politics, then ten years is an eon in technology. In reality, anything could happen between now and 2035 to send progress hurtling off in completely unexpected directions. Read Full Article…

HVBA Article Summary

1. Bioprinting – Organs On Demand: By 2035, advancements in 3D printing technology might enable the creation of tissues and entire organs tailored to individual genetic profiles. This innovation is expected to address the critical shortage of organ donors and reduce the need for immunosuppressive drugs, thereby lowering the risk of organ rejection and subsequent complications.

2. The Gene Genie – Eradicating Diseases: The application of gene editing technologies, such as CRISPR, may lead to the eradication of hereditary diseases like muscular dystrophy, Huntington’s disease, and some cancers by 2035. The evolution of personalized medicine, designed according to each person's genetic makeup, is anticipated to significantly improve treatment outcomes across a broad spectrum of diseases.

3. The Virtual Healthcare Revolution: The next decade could see a shift from traditional healthcare settings to virtual environments, facilitated by AI and telemedicine. Predictive healthcare will enable early diagnosis and treatment of conditions before they manifest symptoms, while virtual reality and robotic surgery could allow treatments and surgeries to be more precise and less invasive, even when conducted remotely.

How health insurers have fared so far in 2024

By Lauren Berryman - Health insurance companies have grappled with higher-than-expected medical costs all year, rattling investors and prompting strategical and tactical shifts, especially in Medicare and Medicaid. Read Full Article…

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1. Medicare Advantage Revisions: Due to higher costs for older members and lower federal payments, major Medicare Advantage carriers like UnitedHealth Group, Humana, and CVS Health’s Aetna are reevaluating their strategies. This includes potentially revising geographic footprints and benefit designs to improve margins, despite recent legal wins against CMS that enhanced star ratings and bonuses. However, some insurers, like UnitedHealth Group and Elevance Health, are still looking to expand or gain market share, while others like Centene and Cigna are exiting certain markets.

2. Medicaid Market Challenges: The Medicaid sector is experiencing significant fluctuations as insurers manage the fallout from eligibility redeterminations post-COVID-19, with over 24 million people losing coverage. This has resulted in decreased memberships and sicker risk pools. Although insurers like UnitedHealth Group and Centene are facing short-term challenges, some states are increasing their Medicaid payments, and companies like Centene and Molina Healthcare are pursuing expansion through geographic growth and acquisitions.

3. Growth in Health Insurance Exchanges: The individual market, particularly health insurance exchanges, saw a record 21.3 million sign-ups after the latest enrollment period, indicating robust growth and interest. Companies like Centene, Oscar Health, and Highmark are strategically positioning themselves in this sector, with Oscar Health exploring innovative approaches like individual coverage health reimbursement arrangements (ICHRAs) to penetrate the employer market.

Tim Walz on healthcare: 8 things to know

By Molly Gamble - Minnesota Gov. Tim Walz is set to join Kamala Harris on the ballot for the 2024 presidential election, Reuters and The Associated Press reported Aug. 6. Here's what we know about the Democratic vice presidential contender's actions and views on healthcare. Read Full Article…

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1. Healthcare Policy Leadership: Governor Tim Walz of Minnesota, with a robust background in public service as a two-term governor since 2019 and a former U.S. Representative, has been a strong advocate for healthcare as a fundamental human right. His administration has witnessed significant healthcare reforms including the expansion of MNsure, which led to a record number of enrollments in 2024, and the pioneering steps towards establishing a public option to enhance MinnesotaCare. These efforts reflect his commitment to improving healthcare accessibility and affordability for Minnesotans.

2. Insurance and Legislative Challenges: Throughout his governance, Walz has navigated complex legislative waters especially in health insurance. In 2024, he supported the renewal of restrictions on for-profit HMOs in Minnesota's Medicaid program, a move that sparked legal challenges from major insurers like UnitedHealthcare. His legislative period has also seen the passing of important bills aimed at restructuring healthcare delivery, such as the Nurse and Patient Safety Act, which initially faced strong opposition from major health institutions like the Mayo Clinic.

3. Comprehensive Healthcare Reforms: Governor Walz's tenure has been marked by comprehensive healthcare reforms that extend beyond insurance to address pressing issues such as medical debt, prescription drug costs, and mental health services. Notably, he signed the Minnesota Prescription Drug Price Transparency Act and the Alec Smith Insulin Affordability Act, making significant strides in regulating drug prices and improving insulin affordability. His efforts underscore a broad and inclusive approach to healthcare, ensuring that economic or social status does not impede access to necessary medical services.

3 ways to reduce health care costs 

By Arthur “Abbie” Leibowitz - Despite ongoing efforts across the industry to combat rising health care costs, employers continue to face a climbing upward trend. Estimated annual increases to employers' health care spending range from 5.4% up to 8.5%, and KFF's 2023 Employer Health Benefits Survey reports premiums went up 7% last year. Read Full Article…

HVBA Article Summary

1. Streamlining Benefits: Employers can optimize their healthcare spending by auditing existing benefits to identify underutilized or redundant services. Consolidating these benefits reduces administrative burdens and enhances overall efficiency, making the benefits program more manageable and cost-effective. A more streamlined approach allows for a clearer, more integrated experience for employees, potentially increasing their engagement and satisfaction with the available healthcare options.

2. Enhancing Navigation and Decision Support: Introducing expert navigation and decision support can significantly enhance the utility of a benefits program. By ensuring that employees have easy access to expert guidance when choosing and using their benefits, employers can improve healthcare outcomes and reduce wasteful spending. These services help employees make informed decisions, utilize their benefits effectively, and engage more deeply with available healthcare services, thereby maximizing the return on investment for employers.

3. Utilizing Data Analytics: Leveraging advanced data analytics, including AI and machine learning, provides profound insights into employee health trends and benefit utilization. This approach enables personalized health recommendations and can identify cost-saving opportunities, such as alternative medication options or targeted health interventions. By using data to inform benefit offerings and health strategies, employers can address specific employee needs, improve health outcomes, and control rising costs more effectively.

Rural doula program targets maternal health disparities

By Jess Mador - When Bristeria Clark went into labor with her son in 2015, her contractions were steady at first. Then, they stalled. Her cervix stopped dilating. After a few hours, doctors at Phoebe Putney Memorial Hospital in Albany, Georgia, prepped Clark for an emergency cesarean section. Read Full Article…

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1. Unexpected Outcomes and Support Needs: Clark's initial childbirth experience was not as she had planned, resulting in an emergency C-section. Although the medical staff were supportive, she felt the absence of personalized care, which a doula could have provided. This realization led her to become a trained doula to offer the one-on-one support she found lacking during her own experiences.

2. Doula Training and Impact: As a member of Morehouse School of Medicine’s Perinatal Patient Navigators, Clark is part of the first graduating class aimed at providing essential support to pregnant and postpartum women, particularly in Black communities in Georgia. This initiative addresses the high rates of maternal mortality and morbidity by equipping doulas with the necessary skills to improve childbirth outcomes and patient satisfaction.

3. Sustainability and Expansion of Doula Services: The program's funding through grants highlights a challenge in sustainability, prompting discussions about long-term solutions like Medicaid reimbursement for doula services. Such funding could decrease medical interventions and costs associated with childbirth, making doula care more accessible and potentially expanding its benefits to broader populations in need.

Most Physicians Are Excited About Clinical Documentation AI, Report Shows

By Katie Adams - Physician burnout soared to a record-high level of 62.8% in 2021, but this issue seems to have been slowly getting better in the years following. Just last week, the American Medical Association released research stating that the nation’s physician burnout has fallen below 50% for the first time since 2020. Read Full Article…

HVBA Article Summary

1. Multifactorial Improvements in Physician Burnout: The reduction in physician burnout levels is attributed to several factors, including the end of the pandemic, increased support staff ratios, the introduction of clinician wellness programs, and critically, the adoption of new technologies. According to a report by eClinical Works, these technologies are designed to ease the administrative burdens that contribute significantly to burnout.

2. Persistent Challenges and AI's Role: Despite some improvements, physicians still face substantial administrative challenges, particularly with documentation. The report highlights that over 40% of physicians spend four or more hours daily on documentation. However, there is optimism that AI technology, particularly AI medical scribes, can reduce this burden significantly by automating clinical documentation, thus freeing up time for physicians to engage more with their patients and focus on less menial tasks.

3. Implementation and Integration of AI Tools: The article discusses the integration of AI tools like Suki, DeepScribe, and Microsoft’s Nuance, which help produce transcripts and draft notes during physician-patient visits. Although these tools offer substantial time savings and the potential for enhanced patient satisfaction, the final review and submission of these documents remain the physician's responsibility. The importance of human oversight in utilizing AI is emphasized, suggesting that while AI offers significant benefits, it should be seen as a complement to the existing workforce rather than a replacement.

Avoiding ERISA lawsuits and breaches of fiduciary responsibility: Lessons from litigation

By Jay Kirschbaum - Recent litigation and agency settlements have reminded employers sponsoring employee benefit plans under ERISA that they are fiduciaries by definition (and their advisors might be functional fiduciaries).  That means that they owe a heightened duty of care to the plans, and more importantly, to the beneficiaries of those plans. Knowing that, employers can take steps to mitigate potential breaches of their fiduciary duty. Read Full Article…

HVBA Article Summary

1. Shift in Litigation Trends: Qualified retirement plans have seen a decrease in excessive fee claims as employers improved the monitoring of fiduciary processes. In contrast, welfare benefit plans, which traditionally faced fewer lawsuits due to the nature of potential awards, are now experiencing an uptick in litigation. This suggests a potential shift where welfare plans might become as litigated as retirement plans due to recent lawsuits and heightened agency scrutiny.

2. Highlighted Lawsuits: Recent lawsuits exemplify the increasing legal challenges facing welfare benefit plans. For instance, a Johnson & Johnson employee sued the company for not negotiating better prices for generic specialty drugs, allegedly causing higher costs for plan participants. Similarly, a Mayo Clinic employee claimed that its health plan and its third-party administrator used misleading pricing methods, leading to inflated participant costs.

3. Employer Responsibilities and Preventative Measures: Employers are advised to take proactive steps to mitigate potential litigation by establishing robust fiduciary processes. This includes forming health and welfare benefits committees, regularly reviewing vendor activities, documenting decision-making processes, and ensuring thorough fiduciary training. These measures can help employers demonstrate compliance and rational decision-making, reducing the risk of successful legal challenges under ERISA guidelines.

Lilly Says Weight Loss Drug Cuts Heart Failure Risk by 38% in Trial

By Deena Beasley - Trial results show Eli Lilly's weight loss drug Zepbound reduces the risk of hospitalization, death and other outcomes for obese adults with a common type of heart failure, the company said on Thursday as it continues to build a case for the medication's wider health benefits. Read Full Article…

HVBA Article Summary

1. Clinical Trial Results: Eli Lilly's drug tirzepatide demonstrated significant clinical benefits in a study involving 731 patients with heart failure with preserved ejection fraction and obesity. The drug reduced the risk of severe heart-related events by 38% compared to a placebo. Additionally, tirzepatide led to an average weight loss of 15.7% in patients, further supporting its efficacy in treating heart failure symptoms and related physical limitations.

2. Market Response and Future Plans: Following the announcement of the trial results, shares of Eli Lilly surged by more than 3% in early trading. The company plans to submit these positive findings to the U.S. Food and Drug Administration and other regulatory bodies later this year, aiming for approval to extend tirzepatide's applications beyond diabetes treatment.

3. Comparative Industry Impact: This development places Eli Lilly in direct competition with Novo Nordisk, whose GLP-1 weight loss drug Wegovy also shows promise in reducing heart failure symptoms. Lilly's success with tirzepatide could reshape treatment approaches for heart failure, particularly among patients with concurrent obesity, a demographic that represents nearly 60% of U.S. cases.

Navigating the maze: HR tech as your guide to benefits administration compliance

By Danika Kimball - The world of employee benefits administration can feel like a labyrinth of regulations and paperwork. Keeping pace with ever-evolving compliance requirements like HIPAA (Health Insurance Portability and Accountability Act), ACA (Affordable Care Act), and FMLA (Family and Medical Leave Act) can be a daunting task for HR departments, especially in today's complex business environment. This is where HR technology (HR tech) emerges as a powerful ally, offering a suite of tools designed to streamline the benefits administration process and mitigate compliance risks. Read Full Article…

HVBA Article Summary

1. Automated Compliance Monitoring: HR tech systems are equipped to monitor benefits administration practices continuously against the relevant regulations. They provide alerts for deadlines and flag potential compliance issues, helping HR departments stay proactive in managing compliance risks.

2. Built-in Regulatory Updates: To cope with constantly evolving laws and regulations, many HR tech platforms automatically update their systems to reflect the latest changes. This feature ensures that organizations are always compliant with the most current legal requirements, reducing the risk of non-compliance.

3. Audit Trail Functionalities: HR technology solutions offer robust audit trail capabilities that track and record all changes, enrollments, and communications related to employee benefits. This feature simplifies the audit process by providing clear and accessible records, ensuring that organizations can quickly demonstrate their compliance during audits.