Healthcare innovations in protective analytics AI, and personalized medicine

By Will Stone and Pien Huang - In my previous article, I explored various tools and technologies that increase productivity while enabling more patient-focused care. I introduced a productivity quadrant chart to highlight where the greatest gains and improvements were occurring. Read Full Article…

HVBA Article Summary

1. Courageous Technical Leadership

   • Why It Matters: Effective technical leadership is vital for aligning technology with organizational goals and enhancing patient experiences. Courageous leaders are willing to prioritize excellence by saying “no” to good ideas in favor of the best ones, fostering a culture that embraces innovation and continuous learning.

   • Impact on Productivity and Patient Care: Strong leaders establish strategic priorities, promote an innovation culture, and allocate resources efficiently, leading to streamlined operations and improved clinical outcomes.

   • Practical Example: A Michigan health system implemented AI-driven documentation tools, allowing clinicians to focus on patient care while reducing administrative burdens, ultimately enhancing work-life balance for healthcare providers.

2. Predictive Analytics

   • Why It Matters: Predictive analytics utilizes historical and real-time data to anticipate patient needs and optimize clinical decisions. It is pivotal for preventive care, efficient resource allocation, and operational excellence.

   • Impact on Productivity and Patient Care: By proactively addressing health risks and optimizing staffing through data-driven models, healthcare systems can reduce treatment costs, minimize wait times, and alleviate clinician burnout.

   • Practical Example: Implementing custom analytics solutions—rather than off-the-shelf products—integrated with EHR systems enables precise forecasting of patient volumes, leading to better staffing decisions and improved patient flow management.

3. Personalized Medicine

   • Why It Matters: Personalized medicine tailors treatments to individual genetic profiles, medical histories, and lifestyle factors, enhancing therapeutic effectiveness and minimizing adverse effects.

   • Impact on Productivity and Patient Care: By delivering targeted treatments and reducing trial-and-error in diagnostics, personalized medicine boosts treatment success rates, reduces costs, and improves patient outcomes, particularly in oncology.

   • Practical Example: Organizations staying informed about advances in genomics and engaging patients in personalized care discussions are better positioned to implement precision medicine strategies that enhance patient satisfaction and clinical success.

Medicare Falls Short: U.S. Seniors Struggle More Than Peers Abroad to Afford Care

By Trudy Lieberman - Since its beginning in 1965, Medicare has been a bright star in American social progress. But it was not set up to pay for all medical expenses of seniors. They can buy supplemental insurance to cover the costs that Medicare doesn’t, and in recent years they have been able to choose an alternative, marketed as Medicare Advantage, that offer some protections. Read Full Article…

HVBA Article Summary

1. High Out-of-Pocket Costs and Unmet Medical Needs: American seniors face significantly higher out-of-pocket healthcare costs compared to their peers in other wealthy countries. Almost one in four U.S. seniors spent at least $2,000 out of pocket on healthcare last year, leading 8% of them to delay or skip necessary medical treatments due to cost concerns. This contrasts sharply with countries like the Netherlands, where only about 1% reported cost-related barriers to seeing a doctor.

2. Lack of Comprehensive Coverage: Medicare's limited coverage for essential services like dental and vision care contributes to the higher financial burden on American seniors. In the U.S., 20% of seniors skipped dental care due to costs, compared to just 4% in the Netherlands and 5% in Germany. This indicates a gap in Medicare's ability to fully support the health needs of older adults.

3. Similar Barriers Across Medicare Plans: The study found no significant differences in cost-related barriers between traditional Medicare and Medicare Advantage plans, despite Advantage plans' supposed lower cost-sharing benefits. Both types of plans expose U.S. seniors to financial challenges that are largely absent in countries with universal healthcare systems, highlighting Medicare's shortcomings in achieving its goal of affordable care access.

CVS taps Ed DeVaney to head Caremark

Emily Olsen - DeVaney will lead CVS’ pharmacy benefit manager after roughly two months in the interim role, the healthcare giant said in a Monday press release. Before serving as interim president at Caremark, DeVaney led sales and account management as president of employer and health plans at the PBM. He joined CVS in 2005, after working at human resources consultancy Hewitt Associates, according to CVS. Read Full Article… 

HVBA Article Summary

1. Leadership Restructuring Amid Challenges: CVS Health continues to undergo significant leadership changes as it navigates challenges in its insurance and pharmacy benefit management segments. Ed DeVaney's appointment as president of Caremark follows a series of executive shifts, including David Joyner's promotion to CVS president and CEO and Steve Nelson's leadership role at Aetna. These changes come as the company grapples with increased medical costs and heightened regulatory scrutiny.

2. Focus on Pharmacy Benefit Management (PBM): DeVaney's leadership at Caremark comes at a critical time when PBMs are under federal scrutiny for their role in drug pricing. The FTC's lawsuit against the nation's largest PBMs, including Caremark, alleges practices that may drive up medication costs. CVS maintains that PBMs play a crucial role in negotiating drug prices and passing savings to clients, countering claims of monopolistic behavior by drug manufacturers.

3. Financial Pressures and Strategic Response: CVS faces financial challenges, with profits significantly impacted by elevated medical spending in its Aetna insurance unit, particularly in Medicare Advantage and Medicaid. Despite these challenges, CVS showed financial improvement in the fourth quarter. The leadership changes, including DeVaney's appointment, signal a strategic effort to stabilize and strengthen the company's position in a highly competitive and regulated healthcare market.

Employers' new ICHRA plans need help from insurers, exec says

By Allison Bell - Employers finally have what looks like a practical way to give workers money that the workers can use to buy their own health coverage — and signing up for the plans is annoying. The Affordable Care Act now makes individual health coverage available to all without underwriting based on health status, and the individual coverage health reimbursement account program offers employers an IRS-friendly way to fund a cash-for-coverage plan. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Growing Investment Interest: Private equity firms are increasingly interested in investing in ICHRA (Individual Coverage Health Reimbursement Arrangements) initiatives, attracted by the model's growing adoption, with over 5 million Americans already covered under ICHRA plans.

2. Challenges in Standardization: Despite the growth, ICHRA plan sponsors and users face hurdles, particularly due to the lack of standardized enrollment processes across insurers. Maya Perl, chief product officer at Zorro, highlights that this complexity often stems from insurers' varied manual application processes and the limited communication capabilities with employers.

3. Opportunities for Innovation: Insurers are beginning to address these challenges by enhancing support for ICHRA users, standardizing data sharing, and leveraging AI-driven decision support tools. These advancements could not only simplify plan selection for employees but also boost health benefits for small and medium-sized businesses by promoting competition among insurers.

FDA OKs First Rapid-Acting Insulin Biosimilar for Diabetes

By Kristen Monaco - The FDA approved insulin-aspart-szjj (Merilog) as the first rapid-acting insulin biosimilar product to treat adults and children with diabetes, the agency announced Friday. Like its reference counterpart, insulin aspart (Novolog), the biosimilar helps lower mealtime blood sugar spikes to improve glycemic control. The approval is for both a 3 mL single-patient-use prefilled pen and a 10 mL multiple-dose vial. Read Full Article…

HVBA Article Summary

1. Enhanced Access and Affordability: The approval of the rapid-acting insulin aspart biosimilar offers a potentially more affordable option for diabetes patients requiring mealtime insulin, helping to improve access to life-saving medication and supporting a competitive marketplace.

2. Comparable Safety and Efficacy: The biosimilar matches the reference insulin aspart (Novolog) in safety and effectiveness, with no clinically meaningful differences. It is administered subcutaneously before meals, with dosing individualized to patient needs, and shares the same side effect profile, including hypoglycemia and allergic reactions.

3. Regulatory and Market Impact: This marks the third FDA-approved insulin biosimilar, reinforcing the FDA's commitment to enhancing the biosimilar approval process. The goal is to boost competition, expand treatment options, and potentially reduce the financial burden of insulin therapy for diabetes patients.

Student loan benefits: The new must-have perk

By Mia Barnes - All businesses should consider creating competitive benefits packages to ensure their long-term success. Employers and human resources professionals can solidify their company’s reputation as an excellent place for people to work by addressing their most pressing challenges — particularly regarding college debt. Learn more about the impact of student loan assistance programs to decide whether to introduce them in your workplace. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Boosted Team Morale and Retention: Implementing a student loan assistance program can significantly enhance team morale by alleviating financial stress and anxiety linked to student loan debt. Employees who feel psychologically supported are more likely to be engaged, productive, and loyal. This sense of value and appreciation fosters a positive workplace culture, potentially increasing retention rates, as 79% of employees are likely to stay when they feel valued, even if salaries aren't as high as they’d like.

2. Financial Incentives for Companies: Companies can benefit financially by leveraging IRS tax deductions, which allow up to $5,250 per employee annually for student loan contributions. This can lead to substantial tax savings, especially for organizations with a large workforce participating in the program. Additionally, structured loan assistance can serve as a strategic investment in talent acquisition and retention, reducing recruitment and onboarding costs linked to high turnover.

3. Competitive Advantage in Talent Acquisition: Offering student loan assistance as part of the benefits package makes a company more attractive to prospective hires, particularly younger candidates burdened with educational debt. This competitive edge can enhance recruitment efforts, drawing in a larger pool of qualified candidates. Real-world successes from companies like Fidelity and Chegg demonstrate the effectiveness of these programs in boosting employee satisfaction and retention, illustrating the potential for both large and growing companies to benefit from implementing similar strategies.

DEA, HHS delay effective date of virtual OUD prescribing rule to March

By Emma Beavins and Dave Muoio - The Drug Enforcement Administration (DEA) and the Department of Health and Human Services submitted an unpublished rule to the Federal Register on Feb. 14 that delays the effective date of the “Expansion of Buprenorphine Treatment via Telemedicine Encounter” final rule, from Feb. 18 to March 21. Also delayed is the effective date of the "Continuity of Care via Telemedicine for Veterans Affairs Patients" final rule. Read Full Article…

HVBA Article Summary

1. Temporary Continuation of Telemedicine Prescribing: The administration clarified that telemedicine prescribing will not be interrupted in the interim, as current COVID-19 telehealth flexibilities remain in place through the end of the year. This allows virtual prescribers to continue their practice under the existing temporary rules while the government collects public comments on the final rules until March 21.

2. Challenges with the Buprenorphine Final Rule: The new rule allows for six months of virtual prescribing for buprenorphine before requiring an in-person evaluation, posing significant challenges for virtual-only providers. Industry stakeholders, including Bicycle Health, argue that this limitation hinders effective online treatment for opioid use disorder (OUD) and advocate for a comprehensive telehealth registration framework to support continuous care.

3. Unresolved Issues and Advocacy for Change: The absence of a finalized special telemedicine registration framework has left gaps in the continuity of OUD treatment. Organizations like Bicycle Health and the American Telemedicine Association are actively pushing for revisions to the proposed rules, arguing that current administrative complexities and operational restrictions would disproportionately impact smaller telemedicine providers and hinder access to care.