IMPACT: After HEALTH CARE un-covered’s Reporting, Medicare Profiteer Shuts Down

By Matthew Cunningham-Cook - In February, HEALTH CARE un-covered published a deep dive into Blue Lantern Health, which before that was Benefytt, and before that Health Insurance Innovations. The firm, owned by Madison Dearborn Partners, a Chicago-based private equity firm with close ties to former White House chief of staff and current ambassador to Japan Rahm Emanuel, exited bankruptcy in September to then run thousands of misleading ads. Read Full Article…

HVBA Article Summary

1. Lack of Disclosure and Oversight: The advertising blitz featuring Joe Namath for Medicare Advantage plans obscured legal troubles faced by the company, including prosecution by federal agencies. Despite this, the Centers for Medicare and Medicaid Services (CMS) did not intervene to prevent the company from supporting questionable Medicare Advantage practices.

2. Bankruptcy and Legal Fallout: Blue Lantern's aggressive marketing tactics and expansive database came under scrutiny during its state-level bankruptcy filing. Litigation revealed extensive dialing of seniors, raising concerns about the company's influence in the Medicare Advantage market and its financial collapse.

3. Regulatory Impact and Advocacy: Reforms introduced by the Biden administration aimed at Medicare Advantage, influenced by advocacy groups, were cited as pivotal in Blue Lantern's demise. These reforms included a cooling-off period and restrictions on national marketing campaigns, signaling a regulatory crackdown on third-party Medicare Advantage lead generators.

Health System Eliminates Noncompetes for Primary Care Physicians

By Sophie Putka - Indiana University (IU) Health will eliminate noncompete clauses for its primary care physicians in a new policy effective December 15. The move will affect nearly 400 physicians, according to IU Health, following both a recent Federal Trade Commission (FTC) ruling and state legislation banning the clauses specifically for primary care physicians. Read Full Article…

HVBA Article Summary

1. IU Health's Progressive Policy Change: IU Health has decided to extend the elimination of noncompete clauses beyond legislative requirements, applying it not only to new hires but also to current physicians, demonstrating a proactive stance towards professional development and patient care.

2. Impact on Physician Mobility: By removing noncompete clauses, IU Health aims to enhance physician mobility within the medical group, potentially allowing for greater career flexibility and the ability to pursue better opportunities without geographic or contractual restrictions.

3. Broader Implications and Industry Response: The move by IU Health reflects ongoing debates in the healthcare sector regarding the role of noncompete clauses. While advocates argue for increased physician autonomy and practice independence, industry groups such as the Federation of American Hospitals have expressed concerns about recruitment challenges and competitive fairness under new regulatory frameworks like the FTC's recent ban on noncompete clauses.

Surgeon General Calls for Social Media to Carry Cigarette-Like Warning Labels

By Associated Press - The U.S. surgeon general has called on Congress to require warning labels on social media platforms similar to those now mandatory on cigarette boxes. In a Monday opinion piece in the the New York Times, Vivek Murthy, MD, MBA, said that social media is a contributing factor in the mental health crisis among young people. Read Full Article…

HVBA Article Summary

1. Call for Surgeon General's Warning Label: Surgeon General Murthy advocates for a mandatory warning label on social media platforms, akin to those on tobacco products, to inform parents and adolescents about the significant mental health risks associated with excessive use.

2. Inadequate Safety Measures: Despite existing bans and safety features, such as age restrictions and time limits, young users easily bypass these controls. Murthy argues that current measures are insufficient and calls for stricter federal regulation to protect minors from online harms like harassment, exploitation, and exposure to harmful content.

3. Comprehensive Legislative Action Needed: Murthy urges Congress to enact legislation that mandates data transparency, independent safety audits, and restrictions on features that encourage compulsive use. He stresses the importance of parental involvement, school policies for phone-free times, and guidance from healthcare professionals to promote safer social media practices among young people.

Pet owners face dilemma after Nationwide drops 100,000 insurance policies

By Mike Snider and Mark Williams - Christie Keith has been paying $600 a month in pet insurance premiums to insure her dogs for years and bumped that up to more than $700 recently to add coverage for her 4-year-old Silkan Windhound, Pip. Read Full Article…

HVBA Article Summary

1. Nationwide Insurance Cancels Pet Policies: Nationwide Insurance announced the cancellation of pet insurance policies for about 100,000 pets nationwide due to rising veterinary costs and financial pressures on their pet insurance business. This move affects many older pets with pre-existing conditions, leaving owners like Keith in a difficult situation as they struggle to find alternative coverage.

2. Impact on Pet Owners: Tens of thousands of pet owners face uncertainty as they lose coverage for their pets. Nationwide's decision, despite claiming it's not based on age or prior claims, disproportionately affects older pets with existing health issues that may not be insurable elsewhere. Many are concerned about the inability to find comprehensive coverage for their beloved pets, given the exclusions of pre-existing conditions by other insurers.

3. Understanding Pet Insurance: Pet insurance, which covers medical care, accidents, and illnesses for pets, is essential for many owners who view their pets as family. With costs averaging $53 per month for dogs and $32 for cats, policies typically come with deductibles and coverage limits similar to human health insurance. Nationwide's decision underscores broader challenges in the insurance industry due to inflation and rising costs, impacting both pet owners' financial planning and the industry's sustainability.

Voluntary benefits sales reach historic highs

By Nick Rockwell - You only need two words to describe the voluntary benefits industry's sales last year: "up again." Or, if you prefer, "historic highs." You may recall voluntary sales grew a solid 5.4% in 2022 — quite respectable as the industry emerged from the lingering effects of the pandemic. But last year topped that with a 6.7% jump, according to Eastbridge Consulting Group's annual "U.S. Voluntary/Worksite Sales Report." Read Full Article…

HVBA Article Summary

1. Record-breaking Premiums:

   • Total sales premium in the voluntary benefits industry soared to $9.34 billion in 2023, marking the highest level ever recorded.

   • In-force premium also hit historic highs, reaching $53.3 billion with a robust growth of nearly 5.5% from the previous year.

2. Leadership in Sales Growth:

   • Benefit brokers led the charge with a remarkable 7% increase in sales, totaling $6.3 billion and capturing 68% of the market share.

   • Career agents and classic worksite brokers each saw substantial sales growth of 11% in 2023, demonstrating their strong influence in the market.

3. Product Performance and Market Optimism:

   • Life insurance remains a cornerstone product, with term life sales up 10% to over $2 billion, securing nearly 22% of all voluntary sales.

   • Sales of various voluntary coverages also showed positive growth: critical illness (+7%), hospital indemnity (+6%), dental (+5%), and others, indicating broad market enthusiasm.

   • Brokers are optimistic about the future, expecting continued client and employee enthusiasm for voluntary benefits, suggesting sustained growth prospects in the coming years.

PSNC 2024: ‘Executive’ Decisions

By Alex Ortolani - Plan sponsors are seeking ways to expand retirement savings options for employees, according to a nonqualified deferred compensation expert speaking recently at the 2024 PLANSPONSOR National Conference in Chicago. Read Full Article…

HVBA Article Summary

1. Shift in Participant Income Eligibility: There's been a noticeable decrease in the income threshold for participation in nonqualified deferred compensation plans. Initially targeting incomes around $200,000 to $250,000, sponsors are now inviting lower income brackets due to limitations in 401(k) deferral amounts, reflecting a broader emphasis on retirement savings.

2. Broader Executive Focus on Retirement: C-suite executives, despite high compensation, face significant gaps in retirement savings. This challenges the perception that such plans are only for the wealthy, highlighting a critical need for income replacement strategies post-retirement.

3. Growing Importance of Financial Wellness: Nonqualified plans are increasingly valued for their role in talent retention and financial wellness. They not only attract high-caliber talent but also support employees in understanding and managing their retirement savings effectively through enhanced education and communication efforts.

Older Women Are Different Than Older Men. Their Health Is Woefully Understudied.

By Judith Graham - Medical research has shortchanged women for decades. This is particularly true of older women, leaving physicians without critically important information about how to best manage their health. Late last year, the Biden administration promised to address this problem with a new effort called the White House Initiative on Women’s Health Research. That inspires a compelling question: What priorities should be on the initiative’s list when it comes to older women? Read Full Article…

HVBA Article Summary

1. Gender-Specific Drug Efficacy: Ensure clinical trials report data by sex and age to determine if medications, like Alzheimer’s drug Leqembi, are equally effective for older women as for men, who currently benefit more significantly from certain treatments.

2. Improved Cardiovascular Care: Address disparities in heart disease treatment for older women, who receive less aggressive care compared to men. Investigate why these biases exist and develop tailored approaches, including better understanding of non-obstructive heart disease prevalent among older women.

3. Enhanced Brain Health Interventions: Focus on reducing cognitive decline and dementia risk in older women through targeted interventions, considering the impact of menopause-related hormonal changes and stressors like caregiving responsibilities. Prioritize comprehensive research on Alzheimer’s disease risk factors across women’s lifespans.

US to stop advance payments for Medicare providers hit by Change hack

By Reuters - The Centers for Medicare and Medicaid Services said on Monday it plans to close the advance payments program it started to help some Medicare providers and suppliers affected by disruptions at UnitedHealth's (UNH.N), Change Healthcare technology unit. Read Full Article…

HVBA Article Summary

1. Launch and Impact of the Payments Program: The CMS launched the payments program in March 2023 in response to a cyberattack on Change Healthcare by the group ALPHV, disrupting medical insurance payments nationwide. The program aimed to stabilize financial flows for healthcare providers.

2. Program Closure and Financial Outcomes: CMS announced the closure of the Change Healthcare/Optum Payment Disruption program on July 12, 2023. By then, it had disbursed over $2.55 billion in accelerated payments to more than 4,200 providers and $717.18 million in advance payments to suppliers, aiding hospitals, doctors, and medical equipment providers.

3. Recovery Efforts and Future Monitoring: As of the latest update, CMS has recovered over 96% of the accelerated and advance payments. Providers are now successfully billing Medicare, though CMS continues to monitor for any residual impacts from the cyberattack. Medicare providers experiencing billing issues are advised to contact Change Healthcare for assistance.

Humana Inc. Defeats Class Action Claims of Excessive 401(k) Fees

By Noah Zuss - A forceful statement from the judge in a recent plan sponsor victory in a 401(k) excessive fee lawsuit could provide some guidance for others regarding the way in which recordkeeping fees are negotiated and monitored, a source said. Read Full Article…

HVBA Article Summary

1. Dismissal of Lawsuit: Federal District Judge Rebecca Grady Jennings dismissed the class action lawsuit, Moore et al. v. Humana Inc., filed against Humana Inc. regarding its 401(k) Retirement Savings Plan. The lawsuit alleged that Humana used an improper process in administering the plan, leading to excessive recordkeeping fees charged by Charles Schwab Retirement Plan Services.

2. Legal Ruling: Judge Jennings granted summary judgment in favor of Humana, ruling that the plaintiffs failed to demonstrate that the recordkeeping fees were unreasonable relative to the services provided. She rejected arguments that Humana's fiduciary duty of prudence was breached due to the absence of a fee policy statement or continuous fee negotiations with the recordkeeper.

3. Impact and Legal Interpretation: Although the ruling does not set binding precedent, it highlights the court's stance on fiduciary duties under the Employee Retirement Income Security Act (ERISA). This decision may influence future cases involving similar allegations against plan administrators and could be beneficial for defendants facing comparable claims.

Mental Health and Aging: The Role of Primary Care in Overcoming Barriers to Treatment

By Reneé Buckingham - Over the last several years, especially since the onset of the pandemic, there has been a great deal of focus on the high levels of depression and anxiety experienced by young Americans who have been open and vocal about their mental health challenges. While that attention is very much needed, we can’t ignore the many older adults who often suffer in silence. While up to one in four adults 65 and older live with a mental health condition, fewer than 50% with mental and/or substance use disorders get needed care. Read Full Article…

HVBA Article Summary

1. The Mind-Body Connection: Chronic physical illnesses prevalent among older adults, such as diabetes, Parkinson’s disease, heart disease, and cancer, significantly increase the risk of developing depression and other mental health conditions. Poor mental health can also exacerbate physical health issues, leading to reduced quality of life and higher mortality rates.

2. The Need for Social Connection: Social isolation and loneliness, affecting a significant portion of seniors who live alone or face physical limitations, contribute to heightened rates of depression, anxiety, and even mortality. Insufficient social connections are linked to increased risks of heart disease, stroke, and dementia among older adults.

3. Economic Stressors: A substantial number of older Americans, particularly among minority groups, struggle with poverty, food insecurity, and housing instability. These economic stressors compound risks for anxiety and depression, further limiting access to necessary mental health care due to financial constraints and social isolation.