Daily Industry Report - February 22

Your summary of the Voluntary and Healthcare Industry’s most relevant and breaking news; brought to you by the Health & Voluntary Benefits Association®

Jake Velie, CPT
Vice Chairman, President & COO
Health & Voluntary Benefits Association® (HVBA)
Daily Industry Report (DIR)

Robert S. Shestack, CCSS, CVBS, CFF
Chairman & CEO
Health & Voluntary Benefits Association® (HVBA)
Daily Industry Report (DIR)

In-network insurance claims jumped after surprise billing ban took effect

By Tina Reed - The amount of in-network care patients received across different specialties and settings jumped significantly as surprise billing protections took effect, according to a FAIR Health analysis shared first with Axios. Read Full Article…

VBA Article Summary

  1. Introduction of the No Surprises Act: The federal No Surprises Act aims to protect insured patients from unexpected large medical bills from out-of-network providers. This legislation, along with similar state efforts, appears to encourage more healthcare providers to join insurers' networks, as suggested by data analysis.

  2. Increase in In-Network Care: Analysis by FAIR Health of approximately 42 billion commercial insurance claims from 2019 to the third quarter of 2023 shows a significant increase in the share of in-network claims—from 84% to 90%. Notably, there was a sharp 2.3% increase immediately after the federal protections began in early 2022, indicating the impact of the No Surprises Act and state laws on healthcare billing practices.

  3. Special Focus on High-Surprise-Bill Specialties: Specialties previously identified as common sources of surprise bills, such as anesthesiology, emergency medicine, pathology, and radiology, saw a 4.7% increase in in-network care, reaching 88.2% of claims. Emergency medicine experienced the most significant rise in in-network claims, illustrating a targeted reduction in surprise billing. Furthermore, the data reveals a closing gap between in-network and out-of-network billing amounts, suggesting a broader normalization of healthcare costs due to legislative actions.

HVBA Poll Question - Please share your insights

What do you believe is the primary factor contributing to the average 20% increase in pharmacy costs as a percentage of total medical spending for businesses:

Login or Subscribe to participate in polls.

Our last poll results are in!


of Daily Industry Report readers who responded to our last polling question “absolutely believe and would engage in the legal importation of specialty medications” when asked if they would advise clients to import speciality or high cost brand drugs like Ozempic, Mounjaro, Wegovy from abroad to save 35-50% off U.S. prices of $850, $1,070, $1,670 per month respectively.

26.83% of respondents have no opinion on the matter or are neutral, neutral or uncertain, 25.25% would consider it, but not too familiar with the process, while 20.41% do not believe or have trust in medications being sourced outside of the U.S. pharmacies.

Have a poll question you’d like to suggest? Let us know!

Tools for Better Data Interoperability Are Here — But Providers Aren’t Adopting Them

By Katie Adams - The healthcare industry has notoriously struggled with disconnected data systems and a lack of interoperability. When health information cannot be easily exchanged between different systems and providers, it leads to fragmented care, medical errors and delays in treatment — not to mention an incredible amount of frustration and inconvenience for both providers and patients. Read Full Article…

VBA Article Summary

  1. Adoption Challenges Despite Technological Advances: Despite the development of tools and data sharing standards like FHIR and DICOM aimed at fostering a cohesive and integrated approach to healthcare data sharing, there is a significant adoption problem. Experts, including Alistair Erskine of Emory Healthcare, highlighted during a virtual panel by Reuters Events that most provider referrals are still conducted via fax, despite the availability of digital tools that could streamline the process. Erskine pointed out that 98% of referrals are done by fax, even though electronic methods are feasible, emphasizing the ease of traditional methods over navigating digital systems.

  2. Barriers to Digital Transition and Efforts to Overcome: The reluctance to transition to digital referrals stems from various hurdles, such as the need for secure logins, difficulty in finding patient information across different systems, and the convenience of using fax. Erskine discussed efforts by Emory Healthcare to simplify the process for providers by embedding links for single sign-on and in-context patient lookups in their systems, aiming to eliminate the need for multiple logins and make patient information more accessible. These initiatives represent steps towards addressing the interoperability and ease-of-use concerns that hinder the adoption of digital referral tools.

  3. Insights from Industry Leaders on Enhancing Interoperability: Micky Tripathi, head of The Office of the National Coordinator for Health Information Technology (ONC), echoed Erskine's observations on the adoption issues and shared a personal experience to underline the interoperability challenges within the healthcare system. Despite known interoperability networks like Carequality connecting hospitals, the preference for faxing or physical document transfer persists, as demonstrated by the experience with his mother's transfer between hospitals. Tripathi advocates for more significant efforts in training healthcare staff and integrating user-friendly electronic referral tools within EHR systems to encourage a shift away from faxing towards more efficient and secure digital data sharing practices.

'New set of digital table stakes': Most executives see tech as worthy investment, EY survey finds

By Anastasia Gliadkovskaya - Nearly all healthcare executives believe new digital health technologies are worth the cost, even though they have yet to see a financial return from it, a new survey reveals. Read Full Article…

VBA Article Summary

  1. Digital Health Solutions Surge Post-COVID-19: The inaugural Health Pulse Survey conducted by Ernst & Young highlights a significant increase in the appetite for digital health solutions among payer and provider administrative executives in the U.S., spurred by the COVID-19 pandemic. The pandemic acted as a catalyst, forcing a shift towards digital health technologies as a necessity for maintaining patient connections. Despite substantial investments in technology, the costs of care remain high, with many providers operating at a loss, underscoring the urgency for a fundamental restructuring towards more digital solutions.

  2. Investment in AI and Operational Efficiency: The survey reveals a notable trend towards integrating AI into healthcare processes, with 60% of executives reporting active investment in AI-based applications. This shift has led to considerable reductions in wasted time and financial costs. Furthermore, 90% of executives acknowledge that digital health technologies have enhanced operational efficiency by shifting administrative responsibilities away from providers, indicating a positive impact on the healthcare system’s functionality.

  3. Challenges and Opportunities in Digital Health Integration: Despite the positive effects of digital health technologies on operational efficiency and provider credibility, challenges remain in fully harnessing their potential. Areas such as care coordination and referral management require more comprehensive integration to move beyond point solutions. While 70% of executives report that overall hospital expenses have not decreased with the adoption of digital tools, a strong majority believe in the worth of the initial investment and the potential for cost reduction through digital health solutions, pointing towards an optimistic future for a digitally enabled healthcare ecosystem.

Top 6 billionaires in US healthcare

By Kelly Gooch - The latest Bloomberg Billionaires Index, which consistently ranks the world's 500 richest people across industries, includes six leaders from U.S. healthcare. Read Full Article…

VBA Article Summary

  1. Thomas Frist Jr., MD, Leads U.S. Healthcare Wealth: With a net worth of $27.4 billion, Dr. Thomas Frist Jr. tops the list of the wealthiest individuals in U.S. healthcare. As a co-founder of HCA Healthcare, his wealth reflects the success of one of the nation's leading for-profit hospital operators. His year-to-date financial growth adds $2.85 billion to his fortune, ranking him 61st overall in the Bloomberg index.

  2. Diverse Contributions to Healthcare Wealth: The list showcases a variety of contributions to the healthcare sector, from medical device manufacturing, represented by Carl Cook of Cook Group with an $11.3 billion net worth, to groundbreaking pharmaceuticals, highlighted by Patrick Soon-Shiong, MD, inventor of Abraxane and founder of NantWorks, with a net worth of $10.6 billion. These figures demonstrate the diverse avenues through which impactful innovation and leadership contribute to individual wealth in the healthcare industry.

  3. Significant Wealth from Medical Equipment and Philanthropy: The Stryker family members and Reinhold Schmieding also stand out for their substantial wealth derived from the medical equipment industry. Ronda Stryker, with a net worth of $9.45 billion, and Pat Stryker, with $7.61 billion, benefit from their stakes in Stryker Corp., while Reinhold Schmieding, founder of Arthrex, has a net worth of $5.74 billion. Their fortunes underscore the significant impact of medical equipment and devices on both healthcare innovation and personal wealth.

When people thrive, business thrives: The case for human sustainability

By Sue Cantrell, Jen Fisher, Joanne Stephane, Jason Flynn, Amy Fields, and Yves Van Durme - We are operating in a human-powered economy. Organizations are at a watershed moment, with many having transitioned from an industrial economy to a knowledge economy and now to an economy that is powered by the hearts, minds, and essential human traits of people—in short, our humanity. Read Full Article… 

VBA Article Summary

  1. Human Sustainability as Core to ESG Initiatives: Organizations are recognizing the importance of their people—from employees to customers and community members—as central to their value, encompassing aspects such as innovation, brand relevance, and productivity. To enhance the social dimension of ESG (Environmental, Social, and Governance), there's a shift towards human sustainability, focusing on creating value for people in terms of health, skills, employability, and connection to purpose. This shift, exemplified by initiatives like those of global distillery Cuervo, focuses on making individuals employable for life rather than offering lifelong employment.

  2. Challenges and Opportunities in Redefining the “S” in ESG: Despite the growing emphasis on ESG, many organizations struggle with the social component due to vague definitions, lack of standardized metrics, and a legacy mindset focused on extracting value from people. The article discusses the need for a paradigm shift towards human sustainability, which not only adds value to individuals across multiple dimensions but also addresses broader social inequities and systemic issues. It highlights the inadequacy of current efforts, which are often fragmented and fail to comprehensively tackle the structural challenges affecting human sustainability.

  3. Strategies for Advancing Human Sustainability: The article outlines actionable strategies for organizations to advance human sustainability. These include focusing on outcome-based metrics, making a business case for human sustainability, tying leader and manager rewards to sustainability metrics, integrating governance into the board and C-suite, and involving workers in co-creating roles and initiatives. Examples of leading practices from companies like PayPal, which has implemented programs to improve workers’ financial health, illustrate how organizations can create a beneficial cycle where improving human outcomes enhances organizational outcomes, contributing to a better future for all.

Common US Food Additives May Cause Cancer

By Pandora Dewan - Scientists have issued a warning after finding a common food additive may be associated with an increased risk of cancer. In the U.S, over half of our daily energy intake comes from ultra-processed foods—foods that usually contain a long list of unrecognizable ingredients like preservatives, emulsifiers, sweeteners and artificial flavorings and colors. Read Full Article… 

VBA Article Summary

  1. Link Between Ultra-Processed Foods and Cancer Risk: A study published in PLoS Medicine by French researchers has found evidence that emulsifiers, common additives in ultra-processed foods like ready meals, cakes, cookies, breads, and spreads, may increase the risk of cancers, especially breast and prostate cancers. These additives include modified starches, xanthan gum, pectins, and mono- and diglycerides of fatty acids (E471), with a particular focus on the latter.

  2. Study Findings and Specific Risks: The research analyzed data from 92,000 adults in the NutriNet-Santé cohort study over an average follow-up of seven years. It revealed that high dietary intake of mono- and diglycerides of fatty acids (E471) was associated with a 15% increased risk of developing cancer overall, with a 24% higher risk of breast cancer and a 46% higher risk of prostate cancer. Carrageenan (E407) was also linked to a 32% increased risk of breast cancer among women.

  3. Implications for Food Additive Regulations: The findings highlight the need for further research to confirm these results globally and underscore the importance of re-evaluating food additive regulations to better protect consumers. The study's lead authors, Mathilde Touvier and Bernard Srour, emphasize the contribution of this research to the ongoing debate on food safety and the potential health impacts of food additives.

Lawmakers float 'essential health system' designation to help direct funds toward safety-net hospitals

By Dave Muoio - A pair of representatives unveiled legislation that would designate more than 1,000 nationwide hospitals as “essential health systems” under federal statute, a first step the bipartisan lawmakers and hospital industry supporters say would give Congress new targets for funding, health equity initiatives or other efforts. Read Full Article…

VBA Article Summary

  1. Introduction and Support for Vulnerable Communities: The Reinforcing Essential Health Systems for Communities Act, introduced by Rep. Lori Trahan, D-Massachusetts, and Rep. David Valadao, R-California, aims to support healthcare providers that serve vulnerable families across the United States. The legislation focuses on ensuring that hospitals catering to the most at-risk populations receive necessary funding and support to continue and enhance their critical services. This initiative recognizes the vital role these institutions play in maintaining public health and addressing disparities in healthcare access and quality.

  2. Criteria for Hospital Designation: Under the proposed act, private nonprofit or nonfederal government hospitals can qualify for a new designation if they meet one of three criteria: having a Medicare disproportionate patient percentage of at least 35%, possessing a Medicare disproportionate share hospital uncompensated care payment factor of 0.0005 or more, or meeting Medicaid’s requirements for disproportionate share hospital status. This designation is flexible for states that do not recognize disproportionate share hospital designations, aiming to inclusively support hospitals that provide significant uncompensated care to Medicaid, low-income Medicare, or uninsured patients, often delivering five times more uncompensated care than other hospitals.

  3. Impact and Industry Support: The act has garnered support from hospital industry groups such as America’s Essential Hospitals (AEH) and the Alliance of Safety-Net Hospitals, highlighting the historical underfunding and operational challenges faced by safety-net facilities. AEH emphasizes that the designation would not only facilitate new funding streams for essential operations, health equity initiatives, and emergency preparedness but also provide a strategic tool for targeting public health resources during emergencies. The organization underscores the importance of such a designation in improving resilience and financial stability for hospitals with a safety net mission, especially in the wake of public health crises like the COVID-19 pandemic

Leaders keep kicking the same healthcare cans down the road

By Molly Gamble - Healthcare is stuck in a rut, with many of the same daily events and problems stemming from long-standing systemic issues that are sorely in need of urgency, attention and insistence for improvement. Read Full Article…

VBA Article Summary

  1. Hospital Closures and Financial Solvency: The issue of hospital closures becomes significant to lawmakers typically only when closure announcements are made, often too late to address concerns for patient safety and care quality. An example highlighted is Dallas-based Steward Healthcare, which faced financial difficulties, drawing attention from lawmakers and officials only after local reporting by The Boston Globe on its Massachusetts hospitals. This situation underscores the need for earlier intervention and scrutiny to ensure both financial stability and care quality in hospitals.

  2. Hospital Staff Safety Legislation: The introduction of the Safety from Violence for Healthcare Employees Act, aiming to make assaults on hospital workers a federal crime, addresses the rising violence in healthcare settings. Despite this legislative effort, incidents of violence and harassment against healthcare workers continue, highlighting the urgent need for effective protections to safeguard those in the healthcare profession, especially in the wake of increased hostility during the COVID-19 pandemic.

  3. Healthcare Workforce Shortages: The U.S. faces significant healthcare workforce shortages, with over 8,300 designated primary care shortage areas. Some areas have been recognized as such for decades, indicating systemic issues in addressing these shortages. The lack of comprehensive data on healthcare workforce turnover and deficits exacerbates the problem, hindering effective policy and intervention strategies to alleviate the shortage and improve access to healthcare services.

FTC obtains $195M judgment against Simple Health for selling ‘sham’ insurance

By Rebecca Pifer - The Florida district court judge’s decision closes a case that’s wound on for half a decade, though Simple and Dorfman could still appeal. In the order, Judge Darrin Gayles called Simple’s actions a “classic bait and switch scheme — aided by rigged internet searches, deceptive sales scripts, and predatory practices.” Read Full Article…

VBA Article Summary

  1. Federal Judge's Decision Against Simple Health: A federal judge ruled in favor of the Federal Trade Commission (FTC), obtaining a $195 million judgment against Simple Health for deceiving tens of thousands of consumers. The Florida-based company was found guilty of selling "sham" health insurance, leading consumers to believe they were purchasing comprehensive coverage that included preexisting conditions, prescription drugs, and hospital care, among other services. Instead, consumers received a medical discount membership with limited benefits, costing up to $500 a month and resulting in significant unexpected bills.

  2. Deceptive Marketing Practices: The FTC's complaint highlighted that Simple Health and its affiliates engaged in deceptive marketing strategies to lure consumers looking for health insurance. This included using trusted insurance brand logos, such as Blue Cross and Blue Shield, on their websites and employing telemarketers with misleading sales scripts. These tactics created fear and urgency, pushing consumers towards purchasing inadequate insurance products. From 2014 to 2018, Simple Health amassed $180 million in commissions, while many customers suffered from the inability to afford necessary medical treatments and incurred high medical expenses.

  3. Legal and Regulatory Repercussions: The court's ruling not only imposed a significant financial penalty on Simple Health but also banned the company and its CEO, Steven Dorfman, from selling or promoting healthcare products in the future. The judgment also mandates the liquidation of Simple Health’s assets to refund affected customers. This case underscores the government's stance against deceptive health insurance practices and highlights the ongoing debate over the value and integrity of association and short-term health plans, particularly in the context of the Affordable Care Act's consumer protections.


States ranked by projected growth in new cancer cases

By Erica Carbajal - The U.S. is projected to see more than 2 million new cancer diagnoses this year, marking a record high, according to estimates from the American Cancer Society. Arizona is estimated to see the largest jump in new cases relative to how many were reported in the state in 2020. Read Full Article…

VBA Article Summary

  1. Nationwide Surge in Cancer Diagnoses Predicted by 2024: Becker's analysis of CDC data from 2020 and projections for 2024 shows an expected increase in cancer cases across all states, with a minimum growth rate of over 11%. This highlights a significant rise in cancer diagnoses within a four-year span, emphasizing the growing health challenge nationwide.

  2. Top Five States with Sharpest Increase in Cancer Cases: The top five states with the highest projected percentage increase in cancer cases by 2024 are Arizona (32.63%), Delaware (32.61%), Oregon (30.08%), Rhode Island (29.86%), and Nebraska (27.03%). These states are set to experience the most substantial growth rates, indicating regional differences in the escalation of cancer incidences.

  3. Caution Advised in Data Interpretation Due to COVID-19 Disruptions: The CDC advises caution in interpreting the 2020 data due to the impact of the COVID-19 pandemic on cancer screenings and reporting. This factor, along with the acknowledgment that state estimates for 2024 might not sum up to the national total due to rounding, suggests that while the projected increases are significant, they are subject to the limitations and variances in data collection and estimation methodologies.