'Worse than a cyberattack': 10 notes on the Microsoft-CrowdStrike IT outage

By Giles Bruce and Laura Dyrda - Hospitals and health systems continue to recover from a July 18 IT issue disrupting service for some Microsoft customers. Read Full Article…

HVBA Article Summary

1. Immediate Impact and Initial Response: On July 18, CrowdStrike released a flawed software update that globally disrupted IT systems, particularly affecting Microsoft's customers and approximately 8.5 million Windows devices. Health systems began experiencing issues on July 19, leading to significant disruptions in operations. Kaiser Permanente activated its national command center, and several health systems, including Banner Health and Mass General Brigham, had to postpone surgeries and close outpatient facilities to manage the crisis.

2. Restoration Efforts and Challenges: Microsoft's engineers, in collaboration with Google Cloud, Amazon Web Services, and CrowdStrike, are working to restore services and provide support to affected customers. CrowdStrike has issued warnings about hackers distributing a malicious file disguised as a quick fix. The disruption affected critical EHR systems like Epic and Meditech, with Providence Health experiencing severe impacts on their IT network and computer systems, causing major operational challenges.

3. Strategic and Long-Term Responses: Health systems are using this incident as a learning opportunity to improve future IT outage preparedness. Leaders like Jack Kufahl from Michigan Medicine emphasized the importance of enhancing communication processes across IT, vendors, and healthcare operations. CommonSpirit Health highlighted the need to balance proactive vendor updates with potential risks. The American Hospital Association issued a cybersecurity advisory to aid hospitals in managing the ongoing recovery, stressing the importance of coordination between Microsoft, CrowdStrike, and healthcare providers to mitigate the impact on patient care.

CMS cracks down on ACA brokers to prevent plan switching

By Rebecca Pifer - Third-party agents and brokers help people shop between ACA coverage and select a plan that best fits their needs. However, the intermediaries have come under increased criticism for switching people’s plans without their consent to gain commissions. Read Full Article…

HVBA Article Summary

1. New Restrictions for Insurance Agents and Brokers: The Biden administration has implemented new measures to prevent unauthorized changes to consumer plans on the federal Affordable Care Act marketplace. Agents and brokers can no longer alter enrollments unless they are already associated with the consumer, requiring additional steps like a three-way call with the beneficiary and the marketplace’s call center or having the beneficiary make changes through HealthCare.gov.

2. Consumer Complaints and Immediate Actions: In response to almost 208,000 complaints from consumers about unauthorized plan changes or enrollments in the first half of the year, the CMS has taken immediate action. This includes suspending 200 agents suspected of unauthorized activities between late June and mid-July. The CMS is committed to robust oversight and anticipates further suspensions in the coming months.

3. Educational Campaign and Broader Measures: To address and prevent marketplace fraud, the CMS has launched a social media campaign to educate consumers about potential fraud signs. Additionally, the CMS has moved to limit broker influence on Medicare Advantage plan selection by capping compensation from insurers, although this cap has been temporarily paused by a judge for further review.

Nailing it: Selling your benefits strategy to senior execs

By Bryce Sanders - Sometimes you are on stage and the spotlight is on you and only you. As a benefits professional, you have been trained to get in front of the decision maker. This often requires many preliminary meetings, impressing the right people as you climb the mountain. In other situations you have entered into competition through a request for proposals (RFP). Read Full Article…

HVBA Article Summary

1. Be Thoroughly Prepared and Rehearsed: Approach your presentation with the same dedication and passion as an actor in a Shakespearean play. This means knowing your material inside and out and delivering it with confidence and enthusiasm. Engage in thorough rehearsals, similar to how lawyers moot before presenting a case to the Supreme Court, to ensure you can deliver your points effectively and persuasively.

2. Leverage Reinforcement and Backup: Utilize the support of influential colleagues or peers who can vouch for your ideas. This can help ease any natural caution or resistance from decision-makers. Additionally, consider bringing an expert from your home office who has relevant experience and credibility in the industry you are addressing. This can provide additional weight and reassurance to your presentation.

3. Respect Time and Make Clear Points: Stick to your allotted time and make it clear at the outset how long you will be presenting and what points you will cover. This shows respect for the audience's time and keeps your presentation focused. Structure your message like a newspaper story, delivering the main points upfront and expanding on them concisely. Be prepared to back up your assertions with documented evidence and avoid bluffing if you don't know an answer. Finally, clearly state your call to action and the next steps, aiming to secure the decision you are seeking.

Illinois bans step therapy, health plan prior authorization for emergency mental health care

By Ryan Golden - Of the two components highlighted in Illinois’ legislation last week, the state’s ban on step therapy is “a lot more interesting,” according to David Shillcutt, attorney and member of the firm at Epstein Becker Green. Read Full Article…

HVBA Article Summary

1. New Legislation on Step Therapy and Prior Authorization: Illinois Governor J.B. Pritzker signed H.B. 5395 into law on July 10, prohibiting health insurers from requiring step therapy and mandating prior authorization for certain emergency mental health treatments. This law aims to return medical decision-making to patients and their physicians, addressing practices that hinder affordable and accessible care. Set to take effect on January 1, 2025, it does not apply to self-insured health plans governed by ERISA.

2. Implications for Health Plans and Spending: Shillcutt highlighted that while some health systems already bypass prior authorization for emergency mental health admissions, Illinois is a pioneer in restricting utilization management practices like step therapy. The ban could lead to increased prescription drug benefit spending, prompting employers to consider navigators or additional services for evaluating treatment options. Health plans might resort to prior authorization for certain treatments as an alternative.

3. Broader Context of Mental Health Coverage and Utilization: The state’s reforms are set against a backdrop of ongoing mental health challenges within the U.S. workforce. Reports indicate significant underutilization of mental health benefits by employees, with barriers such as access and time constraints. Nationally, the Biden administration is pushing for mental health parity in insurance coverage, proposing rules to eliminate prior authorization for mental health and substance use disorder treatments, with a final rule anticipated soon.

People Without Diabetes Make Up Growing Share of GLP-1 Users

By Kristen Monaco - The proportion of new users of GLP-1 receptor agonists without type 2 diabetes markedly increased over the past decade, and particularly since 2020, according to a nationwide population-based study of prescribing trends. Read Full Article…

HVBA Article Summary

1. Increasing Incidence of GLP-1 Agonist Prescriptions: The annual incidence of new GLP-1 agonist prescriptions rose from about 0.5% in 2019 to over 3% in 2023. This significant increase highlights the growing acceptance and use of these medications in medical practice.

2. Shift in Prescription Demographics: From 2019 to 2023, there was a notable decrease in the proportion of new GLP-1 users with type 2 diabetes (from nearly 90% to just over 70%). Concurrently, there was a twofold increase in users without type 2 diabetes but with a BMI of 30 or greater, or a BMI of 27-30 with an obesity-related comorbidity (from about 10% to roughly 25%).

3. Broadening Indications and Potential Impact on Access: The approval of semaglutide for chronic weight management in 2021 and for heart disease prevention in 2023, along with the recent approval of tirzepatide for weight control, has broadened the indications for GLP-1 receptor agonists. This expansion may influence access and raise concerns about medication shortages for diabetes patients.

Are you doing your due diligence on ACA compliance?

By Maxfield Marquardt - In its 14th year of existence, the Affordable Care Act (ACA) is firmly established as an integral part of the U.S. healthcare system. Yet, many employers required to comply with the law find it a struggle to stay on top of its many intricacies. Read Full Article…

HVBA Article Summary

1. The High Stakes of ACA Compliance: Nearly 70% of organizations find ACA compliance burdensome, and non-compliance can lead to exorbitant IRS penalties, often surpassing $1 million. Larger organizations, especially those with over 500 employees, are six times more likely to be fined compared to smaller ones. As a broker, the risk of non-compliance falls heavily on you, and clients will turn to you for solutions when they receive an IRS penalty letter. It is crucial to have a robust ACA compliance strategy to protect your clients and maintain your status as a trusted advisor.

2. Challenges and Risks for Brokers: The complexity of ACA compliance, particularly for organizations with variable hour, part-time, and seasonal employees, poses significant challenges. Brokers without a comprehensive ACA compliance service or a vetted provider risk losing clients who face harsh penalties due to compliance gaps. Clients with predominantly full-time workforces also have their own set of compliance challenges, such as eligibility and enrollment data issues. Failing to address these can lead to serious repercussions, including loss of clients and the associated revenue.

3. Solutions for Effective Compliance Management: Engaging with a solutions provider that offers ACA reporting software and expert support can ease the compliance burden. Tools that ensure data quality, regulatory compliance, and monthly monitoring can help clients avoid penalties. Brokers should aim to offer a comprehensive ACA compliance solution to maintain their BOR status and enhance their offering to prospective clients. This approach not only protects clients from costly penalties but also positions the broker as a proactive and reliable partner in the competitive insurance market.

Student loans: Let’s talk about SAVE

By Chirag P. Shah, MD, MPH and Jayanth Sridhar, MD - The Savings on a Valuable Education (SAVE) plan was introduced in 2023 by the Biden Administration and replaces the Revised Pay As You Earn (REPAYE) program. SAVE continues to evolve with new benefits for student loan borrowers. Read Full Article…

HVBA Article Summary

1. Lower Monthly Payments: The SAVE income-driven repayment (IDR) plan can result in lower monthly payments for borrowers because it bases payments on a smaller proportion of one's adjusted gross income compared to other IDR plans. For instance, a single individual earning $32,800 annually or a family of four earning $67,500 or less would have a monthly payment of $0.

2. Income and Family Size Consideration: SAVE allows borrowers to exclude a high-earning spouse's income if they file taxes as "married filing separately." This is different from the previous REPAYE program, where a spouse's income was included in the total income regardless of tax-filing status.

3. Preventing Interest Accumulation: SAVE prevents interest accumulation on both subsidized and unsubsidized loans as long as monthly payments are made. For example, if $100 in interest accrues each month and the monthly payment is $60, the remaining $40 difference would not be charged.

What employers can expect following the end of Chevron deference

By Ryan Golden - It did not take long for federal courts to apply the U.S. Supreme Court’s landmark June 28 decision in Loper Bright Enterprises v. Raimondo overturning the court’s Chevron deference standard. Read Full Article…

HVBA Article Summary

1. Impact of Loper Bright Decision on Overtime Regulations: The high court's decision in Loper Bright has influenced subsequent rulings, with Judge Sean Jordan citing it in his analysis of the Department of Labor's (DOL) overtime regulations. Jordan found that the DOL exceeded its statutory authority with its salary level test, temporarily blocking the rule for state employees in Texas. This decision signals a potential shift in how agency regulations will be reviewed post-Chevron, marking a significant moment for legal challenges to agency authority.

2. End of Chevron Deference and Its Implications: The Supreme Court's decision to eliminate Chevron deference means courts must now use independent judgment to decide if agencies act within their statutory authority. This shift, highlighted by Alex MacDonald of Littler Mendelson and Paul DeCamp of Epstein Becker Green, indicates that agencies like the DOL will need to be more judicious in issuing rules. The ruling could lead to more precise and closely adhered regulations, though it also raises concerns about increased court involvement in policymaking.

3. Future of DOL Regulations and Employer Preparedness: The Loper Bright ruling could stabilize the regulatory landscape by reducing the oscillation of regulations between election cycles. While existing regulations remain, future ones will face stricter scrutiny. Employers are encouraged to stay compliant with current regulations and actively participate in the regulatory process, providing input and challenging vulnerable regulations as needed. Effective communication with legislators may also help create a more stable regulatory environment.

As GLP-1 Demand Goes Up, Access and Coverage Go Down

By Nancy A. Melville - Experts debating the pressing issue of how to prioritize patients in the increasingly common scenario of loss of access or insurance coverage for anti-obesity glucagon-like peptide 1 (GLP-1) receptor agonist drugs argued that comorbidities and obesity severity should strongly warrant continued coverage — while offering key strategies for getting and retaining approval from payers. Read Full Article…

HVBA Article Summary

1. Challenges in Access and Coverage for GLP-1 Medication: Despite the growing demand for GLP-1 medications, access and coverage are decreasing, as highlighted by Dr. Deborah Horn from the University of Texas Health Science Center. Health plans, including those of the Mayo Clinic, are implementing restrictive policies, such as discontinuing coverage for patients who achieve a BMI of 30, which can lead to rapid reversal of weight loss and cardiometabolic benefits upon stopping the medication.

2. Prioritizing Cardiovascular Benefits Over Obesity: Dr. Pam R. Taub from the University of California San Diego School of Medicine emphasizes the importance of framing GLP-1 therapy in terms of cardiovascular benefits rather than solely focusing on obesity. By doing so, insurers are more likely to approve coverage as the prevention of major cardiovascular events aligns with their cost-saving priorities. Dr. Taub notes higher approval rates when prescribing GLP-1s for type 2 diabetes and associated cardiovascular comorbidities.

3. High Costs and the Need for Equitable Access: Dr. William H. Herman from the University of Michigan questions the high costs of GLP-1 medications, noting that their development costs were initially covered under diabetes treatments. He argues that the exorbitant pricing denies access to individuals who could benefit the most, advocating for a pricing model that reflects the lower research and development costs for obesity indications. Alternatives like phentermine-topiramate and oral semaglutide offer more affordable options, but the primary solution should ensure continued access for those who succeed on GLP-1 therapy.