Daily Industry Report - February 28

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)

VIP Admission & CE’s On Us!

Health package talks break down amid broader spending feud

By Lauren Clason - Lawmakers who hoped to address price transparency and lower drug costs are instead negotiating a smaller health care package after talks broke down again amid a broader stalemate over government funding. Read Full Article…

VBA Article Summary

  1. Narrowed Health Legislation Focus: Efforts are now concentrated on a reduced health legislation deal, sidelining extensive health proposals such as codifying price transparency rules, regulating pharmacy benefit managers (PBMs), and limiting billing by off-campus hospital clinics. The streamlined proposal aims to extend certain policies, potentially enhance funding for community health centers, provide partial relief from scheduled Medicare cuts to physicians, and delay cuts to hospitals serving a substantial number of low-income patients.

  2. Contentious Discussions Amid Fiscal Uncertainty: The negotiations occur amidst a broader contention over government spending, with lawmakers struggling to finalize fiscal 2024 funding, facing the threat of significant across-the-board spending cuts if full-year funding bills are not passed by April 30. The health package discussions have escalated to House and Senate leadership due to committee leaders' failure to reach a consensus, raising uncertainties about garnering sufficient support for inclusion in a short-term spending bill.

  3. Inter-Party and Intra-Party Disputes Hampering Progress: The legislative process is hampered by disagreements within and between parties, notably between House Energy and Commerce Chair Cathy McMorris Rodgers and Senate Health, Education, Labor and Pensions ranking member Bill Cassidy, over issues like PBM restrictions in the commercial market, price transparency, and pandemic reauthorization. These disputes, along with differences over opioid program reauthorization and demands for increased community health center funding, complicate the potential for a comprehensive health legislation package.

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!

Obesity, excess weight cost businesses, employees more than $400 billion in 2023

By Alan Goforth - Obesity and excess weight cost U.S. businesses and employees an estimated $425.5 billion last year, a new report from data and analytics company GlobalData found. Read Full Article…

VBA Article Summary

  1. Nationwide Economic Impact of Obesity: Obesity is not only a significant public health issue but also a substantial economic burden on the workforce and employers. The report highlights that approximately 30% of working adults are obese, and an additional one-third are overweight. This condition is linked to increased risks of chronic diseases like heart disease, type 2 diabetes, and hypertension, as well as severe cases of influenza and COVID-19. These health issues lead to heightened healthcare and disability expenses, more workdays lost due to illness or injury, reduced productivity, and a diminished labor force. The overall workplace cost attributed to obesity and overweight totals approximately $425.1 billion, covering higher medical costs, disability payments, workers' compensation, and costs related to absenteeism and presenteeism.

  2. Geographical and Industrial Variations in Obesity Rates: The prevalence of obesity varies significantly across different industries and regions, affecting employers' costs and workforce management strategies. The obesity rate ranges from 22% in the professional and business services sector to 38% in the mining sector, with regional adult obesity rates varying from 24% in Washington, D.C., to 41% in West Virginia. This variability necessitates a nuanced understanding of obesity's economic implications, considering factors such as worker demographics, wages, healthcare costs, and the risk of injury or disability.

  3. Strategies for Addressing Obesity in the Workplace: The report suggests that small steps toward weight reduction can have significant health and economic benefits for employers and employees. A 5% weight loss could remove 22% of workers from the obesity category, while a 25% weight loss could significantly reduce healthcare expenditures. To combat obesity, employers are encouraged to offer insurance coverage and wellness programs that treat obesity on par with other chronic diseases, foster a supportive and inclusive work environment, and provide resources for obesity care and weight management. Comprehensive obesity care benefits, including behavioral therapy, bariatric surgery, and anti-obesity medications, are essential for managing this chronic condition effectively.

Tampa General Hospital CEO on Change Healthcare Breach: They Are Going To Have To Give an Update Soon

By Arundhati Parmar - There have been 48 updates since Optum’s Change Healthcare first identified a malicious attack on its systems from a suspected nation-state on Feb 21, an attack that hat has crippled its ability to process payments. Read Full Article…

VBA Article Summary

  1. Response to Cybersecurity Issue: Tampa General Hospital CEO John Couris expressed dissatisfaction with recent updates from Change Healthcare concerning a cybersecurity issue, emphasizing the lack of specific information and impact on the industry. Despite assurances that Optum, UnitedHealthcare, and UnitedHealth Group systems were unaffected, Couris approached Optum CEO Amar Desai for more details, only to be told that an update would be provided in two days, highlighting uncertainty and the need for definitive answers due to the widespread impact on the government, pharmacy, and health systems.

  2. Impact and Speculation on Change Healthcare's Response: The cyberattack has severely impacted business operations for military and some retail pharmacies worldwide, with Couris speculating that Change Healthcare's system core was compromised and is being held for ransom. He believes Change Healthcare will not pay the ransom due to the lack of guarantees and potential future risks, opting instead to rebuild their systems, a process that may create a financial strain for Tampa General Hospital due to interrupted claims processing and cash flow.

  3. Operational Challenges and Considerations for Tampa General Hospital: The cyberattack's aftermath has forced Tampa General Hospital to consider the significant operational and financial implications of switching clearinghouses, deemed an unviable option by Couris due to the disruptive and lengthy transition process. Despite the current inability to process claims through Change Healthcare, leading to potential cash flow issues, Couris recognizes the necessity to support and wait for the resolution of the situation, highlighting the complexity of dependencies and the severe consequences of cyberattacks in the healthcare industry.

U.S. Opens UnitedHealth Antitrust Probe

By Anna Wilde Mathews and Dave Michaels - The Justice Department has launched an antitrust investigation into UnitedHealth, owner of the biggest U.S. health insurer, a leading manager of drug benefits and a sprawling network of doctor groups. Read Full Article…

VBA Article Summary

  1. Investigation Scope and Concerns: The Justice Department is conducting interviews with healthcare industry representatives to examine UnitedHealth's practices, particularly the relationships between its insurance unit, UnitedHealthcare, and its health-services arm, Optum. The investigation focuses on how Optum's acquisitions of physician groups and other healthcare assets might impact competition and consumer choice. Concerns include whether UnitedHealthcare unfairly favors Optum-owned groups, potentially excluding rival physicians from certain payment arrangements, and how these practices affect compliance with federal rules regarding premium spending and patient care.

  2. Broader Antitrust Efforts: This inquiry into UnitedHealth forms part of a larger initiative by the Biden administration to intensify antitrust enforcement against major U.S. companies, signaling healthcare as a priority sector for these efforts. The administration's approach, led by Jonathan Kanter, aims to rejuvenate monopoly law enforcement, with UnitedHealth being a significant target given its vast revenue, insurance coverage, and healthcare assets through Optum. This scrutiny also extends to UnitedHealth's planned acquisition of Amedisys and involves examining Medicare billing practices and documentation, which could influence payments and compliance with federal spending caps.

  3. UnitedHealth's Position and Previous Challenges: UnitedHealth, while being a previous target of antitrust actions, has managed to overcome past challenges, including a notable case against the acquisition of Change Healthcare, which was ultimately approved despite the Justice Department's concerns. UnitedHealth maintains that Optum and UnitedHealthcare operate independently and collaboratively with competitors. However, the ongoing investigation and a separate antitrust lawsuit by Emanate Health suggest continued scrutiny over UnitedHealth's practices, potentially affecting its future operations and acquisition strategies in the healthcare industry.

Life insurers report improved mortality; actuaries say nothing’s changed

By John Hilton - Several life insurers cited mortality improvements in the fourth quarter for helping to improve life insurance earnings at the end of 2023. Read Full Article…

VBA Article Summary

  1. Improved Mortality and Financial Impact at Globe Life: In the latter half of the year, Globe Life experienced a positive shift in mortality and persistency rates, leading to a significant decrease in policy obligations—$13 million less in life policy obligations and $4 million less in health policy obligations during the fourth quarter. This improvement contrasts with the first half of the year when mortality rates were notably higher, suggesting a return to near pre-pandemic levels and positively impacting the company's financial health.

  2. Industry-Wide Mortality Trends and Projections: Across the life insurance industry, the trend of excess mortality due to the COVID-19 pandemic began to show signs of improvement. Despite this, long-term projections by the Life Actuarial Task Force and the Society of Actuaries Research Institute anticipate continued mortality deterioration into 2023 and 2024, with no expected improvement until 2025. This outlook remains cautious despite recent declines in COVID-19-related deaths and a noted decrease in excess mortality rates in the latter part of the year.

  3. Sector Responses and Outlook: Life insurance companies, including The Hartford Financial Services Group and Equitable Holdings, have reported improved mortality trends, contributing to profitable growth and cautious optimism for future performance. However, the industry remains wary, with projections still accounting for elevated mortality rates in the near term. Companies are closely monitoring these trends to determine if the recent improvements signify a lasting shift towards pre-pandemic mortality levels or if they are temporary fluctuations.

AHIP, AMA and employer groups team up to accelerate digital health adoption

By Heather Landi - Fourteen organizations representing providers, payers, consumer technology companies and employers are teaming up to cut through the noise and raise higher standards for finding digital health solutions that work and are worth the investment. Read Full Article… 

VBA Article Summary

  1. Formation and Funding of Peterson Health Technology Institute (PHTI): The PHTI was established in July 2023 with a $50 million fund to evaluate digital health technologies critically, aiming to sift through the market's hype and pinpoint innovations genuinely beneficial to patients. It emphasizes independent, evidence-based assessments of emerging products, addressing a significant gap in the current market.

  2. The Launch of the Digital Health Collaborative: Supported by the PHTI, the new Digital Health Collaborative aims to enhance the adoption of effective and valuable digital health solutions by bringing together key stakeholders from healthcare and consumer industries, including AARP, AHIP, and the American Medical Association. Initial efforts focus on conducting a national purchaser survey, grantmaking, and organizing convenings to foster the development and scaling of evidence-based, efficient, and equitable digital health innovations.

  3. Strategic Focus and Member Contributions: The Collaborative and PHTI work towards advancing digital health technologies by focusing on research, grant funding, and regular meetings to support the growth of solutions that improve outcomes and reduce costs. Despite PHTI's independent evaluations, the Collaborative aims to share collective insights, collaborate on essential research, and implement programs to boost confidence in and adoption of digital health technologies. Their first grant supported the Digital Medicine Society's project to align digital health products with purchaser evidence requirements, illustrating their commitment to bridging gaps between technological advancements and practical healthcare needs.

MetLife Works with Fidelity Investments® to Offer Guaranteed Lifetime Income through New Retirement Solution

By Judi Mahaney - One of the challenges facing retirees as they approach the next phase of their lives is ensuring that their savings last through retirement. In fact, MetLife research found that a majority (71%) of U.S. employees are concerned about outliving their retirement savings, up from 60% just two years ago. Read Full Article…

VBA Article Summary

  1. Partnership for Enhanced Retirement Security: MetLife is collaborating with Fidelity Investments® to introduce the MetLife Guaranteed Income Program® via Fidelity’s Guaranteed Income Direct, in response to the increased interest and legislative support (highlighted by the SECURE Act) for lifetime income solutions in retirement plans. This initiative aims to make it simpler for employers to provide fixed immediate income annuities within defined contribution plans, thereby helping retirees secure a reliable income stream.

  2. Simplified Access and Implementation: The availability of the MetLife Guaranteed Income Program through Fidelity’s platform is designed to broaden access to immediate income annuities, allowing plan participants the option to convert part of their savings into a steady income post-retirement. This approach emphasizes ease for both plan sponsors in offering retirement income solutions and participants in managing their retirement savings, with the goal of preventing the rapid depletion of retirement funds.

  3. Commitment to Retirement Security: Both MetLife and Fidelity, along with middleware provider Micruity, underscore their commitment to enhancing financial security for retirees. The introduction of Guaranteed Income Direct represents an innovative step in making essential protection products more accessible and supporting positive retirement outcomes, addressing the critical challenge of ensuring sustainable income streams for retirees against the backdrop of potential risks associated with lump-sum withdrawals.

Colorado Moves to Connect Agricultural Workers With Mental Health Resources

By Vignesh Ramachandran - Colorado lawmakers have proposed a pair of measures they say will improve the availability of mental health resources for the state’s agricultural industry, as stress, anxiety, and depression among ranchers and farmhands have emerged as critical issues that have worsened since the coronavirus pandemic. Read Full Article… 

VBA Article Summary

  1. Legislation to Address Rural Mental Health Challenges in Colorado: Colorado legislators are considering two critical bills aimed at improving mental health care in rural areas, where mental health professionals are notably scarce, and suicide rates surpass those in urban settings. These issues have been exacerbated by the pandemic and climate change. The first bill proposes establishing an agricultural and rural community behavioral health liaison to connect state agencies with mental health care providers and community leaders. The second bill aims to enhance and promote suicide prevention resources specifically for agricultural workers, addressing the significant access barriers to mental health care in rural communities.

  2. Focus on Agricultural Workers' Mental Health: The mental health of Colorado's agricultural sector, particularly among migrant workers, is under severe strain due to language barriers, cultural stigmas, and the physically and emotionally taxing conditions of their work. Approximately 8% of Colorado's farms employ Hispanic or Spanish-speaking workers, who may face isolation, extended work hours, crowded living conditions, and limited communication with their families. These challenges often lead to alcohol abuse, suicidal thoughts, and an urgent need for enhanced behavioral health resources.

  3. Community and Legislative Support for Enhanced Mental Health Services: The proposed legislation and community advocates emphasize the need for targeted mental health support for Colorado's rural and agricultural communities. State Sen. Perry Will highlights the geographic and logistical barriers to accessing care, while community leaders like Ere Juarez and Iriana Medina stress the emotional toll on migrant workers and the importance of cultural and linguistic inclusivity in mental health services. The initiative also has personal significance for State Sen. Tom Sullivan, who is driven by his own experience of loss to improve mental health support and suicide prevention efforts in rural districts.

Obesity drug from Boehringer, Zealand succeeds in MASH trial

By Ben Fidler - In recent years, drugs known as incretins have become the industry’s most coveted products, proving able to treat diabetes, help people to lose weight and even protect heart health. Read Full Article… 

VBA Article Summary

  1. Successful Trial for Obesity and Liver Disease Drug: An experimental drug, survodutide, developed by Boehringer Ingelheim and Zealand Pharma, showed promising results in a mid-stage study for treating metabolic dysfunction-associated steatohepatitis (MASH), a liver disease. The trial revealed that up to 83% of participants experienced significant disease improvement without worsening liver scarring, a stark contrast to the 18% improvement rate in placebo recipients. The drug also achieved its secondary objectives, including a positive impact on liver scarring.

  2. Potential Role of Incretins in MASH Treatment: The clinical success of survodutide contributes to the growing evidence that incretin-based therapies might be effective for MASH, a condition linked to liver fat build-up and associated with metabolic diseases like diabetes. This comes amid a broader exploration of new medicines for MASH, following the failure of several promising drugs in advanced trials and the rejection of a potential treatment by regulatory authorities.

  3. Comparisons and Future Prospects: While the detailed impact and safety profile of survodutide are yet to be fully disclosed, its preliminary results are considered comparable to those of Eli Lilly's tirzepatide, another incretin-based drug showing efficacy in MASH treatment. However, analysts have noted the need for caution in directly comparing these drugs due to differences in trial goals, study populations, and criteria for assessing liver scarring improvement. Further research and Phase 3 trials, particularly in obesity, are planned, with results expected in 2025 and 2026.