Daily Industry Report - January 11

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)

DOL issues final independent contractor rule

By Adam DeRose - The Department of Labor announced a final rule on independent contractors Tuesday, as the agency rescinded the Trump-era interpretation that loosened who qualified as an independent contractor. Read Full Article…

VBA Article Summary

  1. Restoration of Multifactor Economic Reality Test: The new independent contractor rule, introduced by the Department of Labor (DOL), reinstates the multifactor economic reality test. This approach assesses the worker-employer relationship based on a “totality of circumstances,” ensuring no single factor is weighted more heavily than others. The six key factors include the worker's opportunity for profit or loss, their investment in equipment, the permanence of the work relationship, the employer's control over the work, the essentiality of the work to the employer's business, and the worker's skill and initiative. This test aims to address misclassification issues where workers are improperly labeled as independent contractors instead of employees.

  2. Impact on Various Industries: While the rule is not aimed at any specific job or sector, its implementation may significantly affect companies like Uber, Lyft, and DoorDash, challenging their practices of categorizing drivers and delivery workers as independent contractors. Jessica Looman, DOL’s administrator of the Wage and Hour Division, emphasized that the rule offers broad guidance across many industries, requiring a fact-based analysis in each case to determine the correct classification of a worker.

  3. Compliance and Implementation Timeline: The new rule is set to be published on January 10 and will become effective on March 11. To aid in compliance, the DOL plans to provide “extensive guidance” for employers. This initiative is crucial for HR departments to understand the changes and ensure adherence to the new regulations, thereby upholding labor protections and preventing the misclassification of employees as independent contractors.

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What is your opinion on Eli Lilly's direct-to-consumer website for telehealth prescriptions and drug delivery, such as Zepbound? Do you think it will positively affect patient access and disrupt the traditional drug supply chain?

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of Daily Insurance Report readers who responded to our last polling question on how prepared they felt they were for the implementation of the Consolidated Appropriations Act (CAA) and its requirements said “What is the Consolidated Appropriations Act?

37.78% of respondents stated they were “Somewhat prepared, 12.59% shared they were “Not prepared”while only 8.15% felt “Very preparedfor the implementation of the CAA and its 2024 requirements. 

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Health Plans Can’t Dodge Paying for Expensive New Cancer Treatments, Says Michigan’s Top Insurance Regulator

By Robin Fields and Maya Miller - In a victory for many cancer patients in Michigan, the state’s top insurance regulator told health plans on Monday that they cannot deny coverage for clinically proven cancer treatments, and she made it clear for the first time that this includes cutting-edge genetic and biologic therapies. Read Full Article…

VBA Article Summary

  1. Michigan Insurance Regulator's Directive: Following ProPublica's report on the denial of cancer treatment for Forrest VanPatten by Priority Health, Michigan's insurance regulator issued a historic directive. This action was motivated by ProPublica's revelations and pressure from state lawmakers. The directive clarifies that insurers must cover new cancer treatments developed with technologies not available when the original law was passed in 1989. Despite a state law mandating coverage for proven cancer drugs, Priority Health had classified the treatment needed by VanPatten as gene therapy, not a drug, leading to his death in February 2020 due to denied access to CAR T-cell therapy.

  2. Response from Priority Health and Legislative Action: Priority Health, which began covering CAR T-cell therapy several years after VanPatten's death, stated that they follow all state and federal coverage requirements. The company initially contested the treatment's efficacy, despite medical consensus. In response, Michigan lawmakers are pushing for an investigation into Priority Health's actions and questioning the state insurance department's enforcement of the statute. Legislators advocate for clearer laws to ensure coverage for modern cancer treatments and prevent similar incidents.

  3. Implications for Future Cancer Treatment Coverage: The insurance department's bulletin and legislative scrutiny aim to ensure that insurers cover advanced cancer treatments, addressing a loophole in the law that allowed insurers to deny such treatments. This move is seen as a significant step in protecting patients' rights and ensuring access to life-saving treatments, with hopes that it will prevent other families from experiencing what the VanPattens endured. The case highlights the ongoing challenges in healthcare insurance coverage and the need for laws to evolve with medical advancements.

Building Stronger Payer-Provider Alliances

By Cheryl Dalton-Norman - The relationship between improved payer-provider collaboration and high-quality, affordable care is well-established, but the degree to which health systems and health plans develop true partnerships for value varies, a recent American Hospital Association (AHA) executive dialogue found. While progress has been made in some areas, there is one notable challenge: a long history of distrust between payers and providers. Read Full Article…

VBA Article Summary

  1. Addressing Social Determinants of Health: Nurse triage, where a registered nurse is the first point of contact for patient triage, plays a crucial role in identifying and acting on social determinants of health (SDOH) such as transportation needs and food insecurity. This ensures patients receive timely care in the most appropriate setting. Research indicates that nurse triage programs aid patients with chronic conditions, who are often affected by SDOH, in adhering to their health management and treatment plans, leading to significant improvements in healthcare outcomes and quality of life.

  2. Decreasing Emergency Department Utilization: Emergency departments (ED) are facing challenges due to staffing shortages and increased patient demand, leading to higher healthcare costs. Nurse triage offers a solution by ensuring patients receive the right care at the right time in the most appropriate setting, thus reducing unnecessary ED visits. This not only lowers healthcare costs but also alleviates financial burdens on patients, considering the high out-of-pocket costs for ED visits. The article provides evidence from two large health systems where nurse triage significantly reduced ED utilization.

  3. Offering Consumer-Friendly 24/7 Access and Support: In today’s healthcare landscape, there is a growing expectation for 24/7 access to quality care. Nurse triage services, available around the clock, provide patients with immediate access to registered nurses, offering evidence-based care and building trust and loyalty among patients towards their payers and providers. This also helps alleviate the burden on physicians by reducing the need for after-hours call duties. The article highlights this as a value differentiator for payers and providers, improving clinical and cost outcomes through timely clinical assessment and appropriate care delivery.

Nearly 1 in 10 teens globally have used ‘budget Ozempic’ laxatives and other risky weight loss products, per study

By Theresa Gaffney - New weight loss medications like Ozempic and Wegovy have garnered a lot of attention in the past year, but they aren’t always easy to get, especially for young people. Instead, teens surfing TikTok often see other options that don’t even require a doctor’s note. Read Full Article…

VBA Article Summary

  1. Widespread Use of Non-Prescription Weight Loss Products Among Adolescents: Recent research published in JAMA Network Open reveals that nearly 1 in 10 adolescents worldwide have used non-prescription weight loss products like Berberine, diet pills, laxatives, and diuretics. The study involved a systematic review of 90 studies with over 600,000 participants aged 18 and under, predominantly from North America, but also including Asia and Europe. A significant finding was that girls are more likely than boys to use these products, with almost 1 in 10 girls having used a weight-loss product in the past year.

  2. Health Risks and Psychological Impacts: The use of non-prescription weight loss products poses immediate and long-term health risks. Short-term, these poorly regulated supplements can stress the heart and other organs. Long-term, they can contribute to increased body weight, the development of eating disorders, low self-esteem, depression, and substance use. Thomas Hildebrandt from Mount Sinai's Center of Excellence in Eating and Weight Disorders highlights the danger of these products, offering temporary weight loss at a significant health cost.

  3. Calls for Regulation and Evidence-Based Treatment: The study underscores the need for more regulation of non-prescription weight loss products, especially for minors. Some regions, like New York State and the U.K., have started implementing bans on the sale of certain weight loss supplements to minors. Additionally, the research stresses the importance of evidence-based medical treatments for obesity to provide safer alternatives to these non-prescription options. Despite the push for better treatments, access issues such as long waiting lists for specialized clinics and insurance coverage remain challenges.

Is Healthcare Transformation Here? Considerations For Leaders

By Darrell Moon - Having managed 10 different hospitals in my career, I am very much aware of misalignments in healthcare. But I was still stunned at a recent healthcare leadership conference to see a slide presented by a large healthcare system. Read Full Article…

VBA Article Summary

  1. Trend in Hospital-Owned Physician Practices: The article discusses how healthcare systems owning physician practices serve as funnel sources into hospitals, a trend that has grown in recent years. This practice, while financially beneficial for hospitals as seen in the 2019 KFF Health News lawsuit example, raises concerns about healthcare spending due to the shift of services from physician offices to hospitals.

  2. Shift in Primary Care Ownership and Healthcare Delivery: It highlights the emerging trend of large non-healthcare entities like Amazon acquiring primary care practices, signaling a shift in the healthcare landscape. This change challenges traditional hospital-centric models, with some of the largest U.S. employers now offering value-based primary care options not owned by hospitals, leading to a potential transformation in healthcare delivery focused more on customer needs.

  3. Strategies for CEOs and Healthcare Leaders: The article advises CEOs to consider fee-based contracts with benefits consultants and embracing direct primary care subscription models. For healthcare leaders, it suggests creating better work environments for primary care providers and exploring the roles of nurse practitioners and physician assistants. These strategies aim to realign healthcare to be more customer-centric and address the challenges of primary care delivery and provider shortages.

4 ways SECURE 2.0 will impact retirement in 2024

By Alyssa Place - With the start of the new year comes another wave of changes to the retirement landscape. As 2024 gets underway, provisions within SECURE 2.0, legislation passed in 2022, will continue to roll out to support retirement preparedness for millions of American workers. Read Full Article…

VBA Article Summary

  1. Expansion and Flexibility of Retirement Savings: SECURE 2.0 introduces provisions that broaden the scope of 401(k) plans, making them more accessible to a wider range of employees. It addresses financial challenges such as student loans and emergency expenses, which often hinder an individual's ability to save for retirement. This legislation is crucial as data shows that a significant portion of employees with access to employer-sponsored retirement accounts do not contribute to them, leading to a majority of American households being financially unprepared for retirement.

  2. Innovative Provisions to Aid Employees with Student Loans and Emergency Expenses: Among the notable changes, SECURE 2.0 allows employers to match a portion of an employee's student loan payments, contributing to their retirement plan. This is a significant step, as many employees are hindered from saving for retirement due to student loan debt. Additionally, the legislation permits the creation of emergency savings accounts linked to retirement plans, helping employees to set aside funds for unexpected expenses, which is vital as many Americans struggle with sudden financial burdens.

  3. Support for Small Businesses and Hardship Withdrawals: The legislation introduces a "starter" 401(k) or 403(b) plan for small businesses, making it easier for them to offer retirement benefits. This is particularly important as a small percentage of small businesses currently provide such benefits. SECURE 2.0 also modifies the rules for hardship withdrawals from retirement accounts, allowing penalty-free withdrawals under certain circumstances, providing financial relief in times of need.

Patients are hurt by diagnostic errors more often than you think

By Tina Reed - Hospitalized patients who died or were transferred to the ICU during their stay experienced a diagnostic error nearly a quarter of the time — and in most cases the error caused harm, according to a new study that's prompting calls to rethink how health systems keep patients safe. Read Full Article…

VBA Article Summary

  1. Significant Prevalence of Diagnostic Errors: The new study highlights the commonality of diagnostic errors in hospitals, revealing alarming statistics: around 23% (550 out of 2,500) of the sampled patients experienced a diagnostic error. These errors can lead to serious consequences, with 18% (436 patients) suffering temporary or permanent harm. In cases of patient death (1,863 patients), diagnostic errors were a contributing factor about 7% of the time. This research follows up on the findings from the "To Err Is Human" report, emphasizing the ongoing risk of human error in medicine.

  2. Potential Risk Factors and the Need for Further Research: The study underscores the need for more research to understand the underlying causes of these errors. Factors like physician workload, patient characteristics, and the complexity of medical conditions could influence the likelihood of diagnostic mistakes. The accompanying JAMA editorial suggests future research should focus on comparing patients with similar diagnoses and severity to better understand the impact of these errors.

  3. Strategies for Reducing Diagnostic Errors: Amidst the rise of AI tools for improving diagnosis accuracy, the study suggests that simple, low-tech approaches might be more effective. One such method is the "diagnostic pause," a deliberate timeout for clinicians to consult with colleagues and review patient histories and test orders. This approach emphasizes the importance of giving healthcare providers time to think and reflect, potentially reducing the likelihood of missing crucial information or making hasty decisions.

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Amazon takes on health systems with new care management program

By Eric Wicklund - Amazon has launched a new service aimed at helping consumers manage their chronic conditions. Read Full Article…

VBA Article Summary

  1. Amazon's Entry into Healthcare: Amazon is joining the healthcare industry with its Health Condition Programs, offering a new alternative to traditional primary care providers. This program, announced at the JP Morgan Conference, marks a significant step for Amazon in the healthcare sector, providing consumers with a digital platform to manage their health.

  2. Personalized Virtual Care Plans: The Health Condition Programs utilize consumers' online search and shopping history to match them with personalized care plans. These plans are designed to be convenient and accessible, offering services such as virtual visits, health coaching, and remote patient monitoring. The program aims to simplify the process of receiving healthcare by checking if it's covered by the employer or health insurance and providing a virtual link to a dedicated care team.

  3. Impact on Healthcare Industry and Partnerships: This initiative by Amazon is set to disrupt the traditional healthcare system, compelling healthcare executives to enhance their virtual care and digital health offerings. Amazon's partnership with companies like Omada Health extends its reach in managing a variety of chronic health conditions. This collaboration highlights the growing trend of virtual-first healthcare and the importance of integrating digital solutions into healthcare management.

3 key takeaways for 2024 from Biden’s AI executive order

By Kevin White and Scott Burton  - On Oct. 30, 2023, President Biden issued a wide-ranging executive order to address the development of artificial intelligence in the United States, titled the Executive Order on the Safe, Secure and Trustworthy Development and Use of Artificial Intelligence. The order seeks to address both the “myriad benefits” as well as what it calls the “substantial risks” that AI poses to the country. Read Full Article…

VBA Article Summary

  1. Mitigation of AI Impact on Employment and Worker Rights: The executive order issued by the administration calls for a federal government-wide effort to address the effects of AI on job security and workers' rights. Key agencies, notably the Department of Labor, are tasked with examining and mitigating the impacts of AI in the workplace. This responsibility primarily falls on human resource and employee relations professionals, who must ensure compliance with the Labor Department's regulations. The focus is on maintaining fair labor standards and protecting workers' rights in the face of growing AI implementations.

  2. Support and Retraining for Displaced Workers: The White House, through the executive order, highlights the risk of worker displacement due to AI advancements. To combat this, the Secretary of Labor is directed to assess the ability of federal agencies to aid workers affected by AI adoption. This includes integrating worker retraining programs through the Workforce Innovation and Opportunity Act with existing unemployment insurance. Additionally, the Labor Secretary is tasked with identifying potential legislative actions to enhance retraining opportunities, reflecting a proactive approach to prepare the workforce for AI-driven changes.

  3. Focus on Organized Labor and AI Principles: The executive order emphasizes the development of AI principles and best practices related to labor standards and job quality. These guidelines are to be established by the Secretary of Labor, with input from labor unions and workers' groups, and will cover various aspects such as AI's impact on job skills, equitable labor standards, and the implications of AI-assisted employee data collection. The National Labor Relations Board is expected to play a significant role in implementing these standards, particularly in areas like bargaining over AI tool usage, compensation determination, and monitoring of worker organizing activities. This focus underscores the administration's commitment to safeguarding workers' rights in an increasingly AI-integrated work environment.