Daily Industry Report - January 23

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)

FTC to bar another data firm from selling consumer location data

By Emily Olsen - Regulators have lately been cracking down on the sale of location data that could link them back to sensitive places like clinics, a growing concern for privacy experts in the wake of the Supreme Court’s decision to overturn Roe v. Wade. Read Full Article…

VBA Article Summary

  1. FTC Actions Against Data Firms: The Federal Trade Commission (FTC) has taken legal action against InMarket Media, accusing the firm of mishandling precise location data by not securing informed consent from app users and retaining the data longer than necessary. This follows similar actions against other data brokers like Outlogic and Kochava for selling location data that could track visits to sensitive locations such as reproductive health clinics.

  2. InMarket Media's Alleged Misconduct: InMarket Media, which gathers location data from its own and third-party apps, is alleged to have used this data for targeted advertising without proper user consent and retained the information for an extended period of five years. Despite categorizing users into specific audience segments for advertising, the firm faces criticism for potentially exposing sensitive information due to these practices.

  3. Company's Response and Measures: InMarket Media has contested the FTC's claims, emphasizing its efforts to enhance sensitive location protections and ensure clarity in the notice and consent processes of its partners. The company also announced a collaboration with a nonprofit to exclude location data near reproductive health clinics from its database, indicating a move towards more responsible data handling practices.

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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 Industry 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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Florida's Drug Importation Plan Is A Bipartisan Blunder

By Sally Pipes - It's not every day that President Joe Biden and Florida Gov. Ron DeSantis agree. But that's exactly what happened this month, when the U.S. Food and Drug Administration green-lit Florida's request to import certain prescription drugs from Canada, where they're cheaper. Read Full Article…

VBA Article Summary

  1. Skeptical Analysis of Drug Importation Plans: While Florida Governor Ron DeSantis advocates for importing drugs from Canada to cut costs, experts and analyses suggest the benefits may be overstated. The nonpartisan Congressional Budget Office estimates that a national drug importation plan would only decrease total drug spending by 1% over a decade. Florida's plan, similar to proposals in other states, is expected to offer marginal savings and would only benefit a fraction of the state's population—less than a quarter of Floridians. Moreover, the savings for the state could be offset by substantial costs involved in ensuring the safety and authenticity of imported drugs.

  2. Challenges and International Relations: The feasibility of Florida's importation plan hinges on cooperation from Canada, which is uncertain. Canadian officials, including British Columbia's Health Minister Adrian Dix, have expressed concerns that large-scale drug importation by the U.S. could lead to drug shortages in Canada, indicating a potential for stringent measures against such importation efforts. Additionally, the focus on importing brand-name drugs from Canada overlooks the availability of cheaper generic drugs in the U.S. and disregards the impact of price controls on drug accessibility and pharmaceutical innovation.

  3. Economic and Innovation Implications: The push for drug importation and price controls, including those proposed in the Democrats' Inflation Reduction Act, may have unintended consequences on the pharmaceutical industry. Price controls could deter investment in new drug development, with the Inflation Reduction Act potentially leading to 139 fewer new drugs in the next decade. The delayed entry of new drugs into the Canadian market due to price controls also underscores the trade-off between cost savings and access to innovative treatments, raising questions about the long-term viability and desirability of drug importation as a strategy to reduce healthcare costs.

What the Health Care Sector Was Selling at the J.P. Morgan Confab

By Molly Castle Work and Arthur Allen - Every year, thousands of bankers, venture capitalists, private equity investors, and other moneybags flock to San Francisco’s Union Square to pursue deals. Scores of security guards keep the homeless, the snoops, and the patent-stealers at bay, while the dealmakers pack into the cramped Westin St. Francis hotel and its surrounds to meet with cash-hungry executives from biotech and other health care companies. After a few years of pandemic slack, the 2024 J.P. Morgan Healthcare Conference regained its full vigor, drawing 8,304 attendees in early January to talk science, medicine, and, especially, money. Read Full Article…

VBA Article Summary

  1. Revolutionary Impacts of AI in Healthcare: At a four-day conference, Nvidia, known for its powerful silicon chips, drew significant attention with promises to revolutionize drug-making by pairing computing power with extensive biological data. While Nvidia's VP of healthcare, Kimberly Powell, hinted at the potential of AI in creating the world's first trillion-dollar drug company, the Mayo Clinic showcased AI's ability to enhance patient diagnosis accuracy. However, the future of AI in healthcare remains uncertain, as exemplified by Nvidia's $100 million deal with Amgen and concerns voiced by biotech industry professionals about the potential disappearance of their field if Big Pharma self-discovers drugs through AI.

  2. Economic Prospects and Ethical Considerations in Weight Loss Drugs: The emerging market for GLP-1 agonist weight loss drugs, predicted to reach $100 billion annually, sparks discussions on economic gains and healthcare coverage. Despite the interest from investors and entrepreneurs, challenges like the high annual cost, insurance coverage issues, and long-term effectiveness of these drugs raise questions about the healthcare system's approach to obesity treatment and the potential bias against those suffering from it.

  3. Financial Strategies and Ethical Dilemmas of Tax-Exempt Hospitals: Nonprofit hospitals showcased their financial stability and revenue diversification strategies at the conference, highlighting their large cash reserves, expansion plans, and partnerships for commercializing research. However, this focus on financial growth and appealing to investors raises questions about the balance between their profit motives and their commitment to providing community benefits, as required by their tax-exempt status.

Business Group: These are the top healthcare challenges employers expect to face this year

By Frank Diamond - Self-insured employers are set to face plenty of challenges this year, ranging from addressing the mental health needs of their workforces to developing strategies for on-site clinics amid a pivot to larger volumes of remote work. Read Full Article…

VBA Article Summary

  1. Escalating Mental Health Concerns and Insufficient Resources: The report reveals a significant spike in mental health issues among employees, with 77% of employers noticing an increase. Ellen Kelsay, the president and CEO of the Business Group on Health, attributes this rise to various factors including the pandemic, economic and political uncertainties, and natural disasters. To address this, employers are expanding support options due to the shortage of mental health professionals and are striving to reduce the cost of care for employees. Moreover, they are reevaluating the functionality of on-site clinics to better align with broader care delivery priorities, potentially driven by a desire to enhance access to primary and behavioral health services.

  2. Rethinking the Role of Virtual Health: Initially seen as a transformative force in healthcare, the perception of virtual health services among employers is now more cautious. Concerns about the actual impact of virtual health on outcomes, quality, and cost are leading employers to question the effectiveness of these services. The report indicates that employers find the market oversaturated with virtual health solutions, complicating the decision-making process for employees. Despite a decline in the perceived impact of virtual health (from 85% in 2021 to 64% in 2023), employers still plan to implement more virtual health services in 2024, albeit with a more selective approach towards vendors to ensure better integration and coordination with existing healthcare providers.

  3. Concerns Over Drug Costs and Vendor Transparency: Employers express growing apprehension about the escalating costs of pharmaceuticals, with 92% concerned about the price of upcoming drugs and 91% worried about the overall trend in pharmacy costs. This concern is validated by an increase in healthcare dollars spent on pharmacy. In response, there is a notable shift towards demanding transparency from Pharmacy Benefit Managers (PBMs), with 73% of employers desiring more data on compensation and pricing to gain insights into drug pricing and address misaligned incentives in the pharmacy supply chain. Additionally, the report underscores the burden of cancer care costs, with a focus on addressing late-stage cancer diagnoses exacerbated by delayed screenings during the pandemic. Employers are responding by emphasizing advanced screening measures and adopting specialized approaches like the cancer-focused center of excellence.

Stakeholders Ready to Adopt CMS' Prior Authorization Final Rule

By Pietje Kobus - The Centers for Medicare & Medicaid Services (CMS) has finalized a rule focused on streamlining prior authorization of medical services. Stakeholders concur that the new rule is a step in the right direction, while some say the rule doesn’t address all current concerns. Read Full Article…

VBA Article Summary

  1. Introduction of New Requirements and APIs for Streamlined Prior Authorization: The new rule mandates various healthcare entities like Medicare Advantage organizations, Medicaid, CHIP, and others, to enhance the electronic exchange of health information and the prior authorization process. This includes the implementation of a FHIR-based Prior Authorization API for a more efficient electronic process and the requirement for certain payers to issue prior authorization decisions within specific timeframes (72 hours for urgent and seven days for non-urgent requests). Furthermore, the rule introduces various other APIs like Provider Access and Payer-to-Payer to facilitate better data sharing and transparency in healthcare services.

  2. Mixed Reactions from Healthcare Industry Leaders: The new CMS rule has elicited mixed responses from industry experts. While some, like CMS Administrator Chiquita Brooks-LaSure and APG’s Susan Dentzer, applaud the move for improving efficiency and patient care, others express concerns. For instance, AAFP's President Steven P. Furr acknowledges the rule's potential in reducing administrative burdens but calls for further legislative actions for substantial progress. Premier Inc. appreciates the imposed deadlines for prior authorization decisions but criticizes the prolonged wait times and the missed opportunity for promoting real-time authorization processes.

  3. Economic Impact and Call for Further Action: The rule is anticipated to significantly reduce the burden on patients, providers, and payers, with an estimated savings of $15 billion over ten years. However, industry players like AHIP stress the need for a comprehensive approach, urging the Office of the Coordinator for Health Information Technology (ONC) to mandate the development of electronic prior authorization capabilities. This holistic approach is seen as crucial for optimizing the benefits of the new rule and ensuring that the healthcare sector can effectively leverage technology to improve efficiency and patient care.

Mayo Clinic launches telehealth access program for new GLP-1 weight-loss drugs

By Alan Goforth - Two popular health-care trends, telemedicine and promising new weight-loss drugs, continue to converge. The Mayo Clinic… announced a new telehealth service that will offer direct access to GLP-1 weight-loss medications, shortly after Eli Lilly similarly launched LillyDirect. Read Full Article…

VBA Article Summary

  1. Introduction of the Mayo Clinic Diet Medical Weight Loss Rx Program: The Mayo Clinic Diet has launched a comprehensive Medical Weight Loss Rx program, providing a range of services including lab testing, clinical monitoring, insurance support, customized meal plans, and educational tools. This beta program, led by Dr. Andres J. Acosta, M.D., Ph.D., is designed to offer a complete clinical weight management solution, ensuring the effective use of weight-loss medications and maximizing the chances of success for participants.

  2. Context and Industry Trends: The Mayo Clinic's new program emerges in response to the increasing popularity of direct-to-consumer telehealth services offering weight loss medications, such as the online service by Eli Lilly for its drug Zepbound. While these medications, including GLP-1s, are becoming more sought after for weight loss, their high costs and the recent trend of reduced insurance coverage highlight the need for comprehensive weight management solutions like those offered by the Mayo Clinic Diet.

  3. Program Offerings and Research Foundations: The Mayo Clinic Diet now offers three distinct programs tailored to different needs: the original online diet program, an Rx companion program for current medication users, and the newly launched Medical Weight Loss Rx program for newcomers seeking medication options. Underpinning these offerings is Dr. Acosta's research, which demonstrates that combining weight loss medication with lifestyle modifications can triple the effectiveness compared to online weight loss programs alone. Additionally, while the Mayo Clinic has imposed a lifetime limit on weight loss medication coverage through its employee health plan, it continues to advocate for integrated approaches to obesity treatment.

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Elevance Health wants to use AI to simplify and personalize healthcare. Here's how the insurance giant is doing it

By Heather Landi - Artificial intelligence dominated the conversation at the Consumer Electronics Show (CES) in Las Vegas earlier this month. Read Full Article…

VBA Article Summary

  1. Elevance Health's Prominent CES Presence and Technological Innovation in Healthcare: At the CES event, Elevance Health, led by CEO Gail Boudreaux, highlighted its commitment to transforming healthcare through technology. Boudreaux emphasized the potential of AI, particularly generative AI, to make healthcare more proactive, predictive, and personalized. The company is focusing on leveraging these technologies to simplify and personalize the healthcare experience for its 117 million users, streamlining both consumer-facing and back-end processes. Elevance's initiatives include integrating AI into every aspect of its business, aiming to address the needs of consumers, providers, and employees, and simplifying complex healthcare processes and documentation.

  2. Strategic Use of AI for Enhanced Healthcare Services: Elevance Health is actively exploring the use of AI and generative AI to refine the healthcare journey for its consumers. The company's approach involves embedding AI within its Sydney app to offer personalized healthcare recommendations and an interactive chat feature, helping members to easily navigate health benefits and connect with suitable providers. Additionally, Elevance is focusing on responsible AI practices, ensuring principles like privacy, security, accountability, transparency, and health equity are at the core of their AI deployment. The company is committed to addressing potential biases, ensuring responsible use of AI, and maintaining transparency to foster trust and understanding among all stakeholders.

  3. Future Directions and Challenges in AI-Driven Healthcare: Looking forward, Elevance Health recognizes both the opportunities and challenges presented by the rapid evolution of generative AI. The company is enthusiastic about the potential for AI to revolutionize healthcare by simplifying complex processes, enhancing data integration, and improving communication among healthcare entities. However, it acknowledges the need for a cautious and responsible approach to AI development and deployment, focusing on building trust, ensuring reliability, and maintaining robust, responsible AI frameworks. Elevance's vision includes a 'people-first' approach, emphasizing the importance of understanding and addressing the real-world needs and pain points of the healthcare community.

Humana warns high medical costs may hit 2024 forecast, shares slump

By Sriparna Roy - U.S. health insurer Humana (HUM.N), opens new tab said on Thursday an increase in demand for medical care among older adults would hurt fourth-quarter results and added uncertainty to its 2024 outlook, sending its shares down 14%. Read Full Article…

VBA Article Summary

  1. Rising Medical Costs and Industry Impact: Humana has indicated an increase in medical costs in the fourth quarter, primarily driven by higher demand for medical services, including orthopedic and heart-related surgeries. This trend, also noted by UnitedHealth, is causing concerns over industry-wide implications, as evidenced by the decline in share prices of major health insurers like UnitedHealth, CVS, and Elevance Health. The heightened demand is particularly notable among those enrolled in Medicare Advantage plans, with an unexpected rise in both inpatient services and outpatient surgeries.

  2. Financial Forecasts and Investor Sentiments: The surge in medical service usage has prompted analysts from J.P.Morgan and Leerink to speculate about potential challenges in meeting future earnings targets, specifically for 2025. Humana has preponed its fourth-quarter results announcement to January 25, aiming to provide a comprehensive update on the yearly forecast. However, concerns linger among long-term investors, particularly regarding the growth prospects in the Medicare Advantage market, a sentiment echoed by Morningstar analyst Julie Utterback.

  3. Strategic Adjustments and Market Reactions: Despite the uptick in medical service demand, Humana reported a lower-than-expected growth in new members during the Medicare annual enrollment period. This shortfall, coupled with the forecast of higher medical costs, is prompting Humana to adjust its 2025 Medicare Advantage pricing cycle accordingly. The company anticipates an adjusted medical benefit ratio of 91.4% in its insurance segment for the fourth quarter, an increase from the previously forecasted 89.5%. This adjustment and the underlying factors are adding to the prevailing investor concerns, reflecting the complex dynamics at play in the health insurance market.

How can hospitals turn the home into a healthcare hub?

By Eric Wicklund - As more healthcare services are accessed in or delivered to the home, health systems and hospitals will have to make significant changes to take full advantage of that setting. Read Full Article…

VBA Article Summary

  1. Hospital at Home as a Growing Trend with Untapped Potential: The concept of delivering healthcare services directly to the patient's home, known as Hospital at Home, has been gaining traction, with more than 300 health systems in the U.S. participating in the Acute Hospital Care at Home model. This approach has demonstrated benefits like improved clinical outcomes and reduced healthcare costs. However, experts argue that the potential of the home as a health and wellness hub remains largely unexplored. Healthcare executives are encouraged to rethink how they collect and utilize data from home settings and to view patients more as consumers. This shift requires not only technological advancements but also a fundamental change in the healthcare delivery model.

  2. Challenges in Data Utilization and Consumer Engagement: While technology exists to facilitate care at home, the healthcare industry faces significant challenges in collecting and leveraging data for preventive health and wellness. Current systems lack the necessary integration of science, technology, and behavioral health to effectively use data for improving health outcomes. Additionally, there is a disconnect between the lifestyle of patients and the healthcare services provided, with a substantial portion of care costs being lifestyle-related, yet minimal investment in behavioral change. The industry needs to develop standards for home-based devices and smart technology to enable seamless data sharing with healthcare organizations.

  3. Collaboration with Disruptors to Enhance Consumer Experience: The healthcare sector is recognizing the importance of partnering with disruptors who excel in reaching and engaging consumers in their homes. As digital health becomes increasingly crucial, there is a significant opportunity for collaboration between traditional health systems and tech companies. Firms like Amazon and Apple, known for their superior customer experience, could play a pivotal role in transforming how healthcare services are delivered and experienced. The industry acknowledges that the transformation towards a more consumer-centric healthcare model cannot be achieved by health systems alone, highlighting the need for partnerships with entities that have expertise in consumer engagement and technology integration.

The high cost of weight-loss drugs is threatening coverage altogether

By Lucy Peterson - The popularity of weight-loss drugs are growing and local governments say their health care budgets can’t keep up. GLP-1s, such as Ozempic and Mounjaro, are a class of drugs that were initially developed to treat type 2 diabetes — which is the most expensive chronic condition in the US, according to Bloomberg. Read Full Article…

VBA Article Summary

  1. Increasing Dependence and Soaring Costs: The use of GLP-1s, primarily for weight loss, is becoming more prevalent among Americans, with a significant portion of the population suffering from type 2 diabetes and obesity. The demand for these drugs is surging, leading to an alarming increase in government spending on these medications. The costs for Medicaid have dramatically risen from $3.3 billion in 2020 to $7.9 billion in 2022, prompting state leaders to consider implementing regulations to control these spiraling expenses.

  2. Policy Changes and Access Challenges: States are beginning to take action in response to the surging costs. Connecticut and Virginia have imposed new restrictions on access to GLP-1s for state employees and Medicaid enrollees, respectively, in an effort to curb spending. Other states are contemplating similar measures. Moreover, there's a growing concern about how the rationing of GLP-1s will be managed, particularly after North Carolina decided that new patients must bear the full cost of the drugs, potentially barring them from receiving essential treatment.

  3. Implications for Public Health: While GLP-1s offer significant health benefits, including potential beyond treating diabetes, their high cost is causing apprehension among medical professionals. They fear that the prohibitive price tag might lead to patients, especially those newly diagnosed or underprivileged, missing out on crucial, potentially life-saving treatments. This scenario poses a significant challenge to public health, raising ethical and practical questions about drug pricing, healthcare accessibility, and the prioritization of medical resources.