Daily Industry Report - March 13

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)

Health & Voluntary Benefits Association® (HVBA) Delivers another successful Benefits Roadshow

By HVBA - The Health & Voluntary Benefits Association® (HVBA) is pleased to conclude our recent event for benefits professionals, the HVBA Benefit Networking Roadshow. This distinguished gathering took place on Thursday, March 7, 2024. Read Full Article…

VBA Article Summary

  1. Continuing Education at the Heart of Professional Growth🎓: This past event wasn't just an opportunity to network; it was a profound educational journey for professionals in the benefits industry. With two Continuing Education (CE) sessions, attendees were immersed in the latest legislative updates concerning the Consolidated Appropriations Act (CAA), Employee Retirement Income Security Act (ERISA), Long-Term Care (LTC), and the complexities of “Junk Insurance.” Insights from industry experts like Rob Shestack, Jake Velie, Amy Nelli, and Dan Robinson were not just enlightening; they were essential in navigating the current regulatory landscape to avoid potential fines. This was more than a meeting of minds; it was an essential update for every professional looking to stay ahead in the field. #EducationFirst #IndustryInsights"

  2. Unforgettable Networking Under the Desert Sky🌵: Imagine combining valuable learning with the unique opportunity to forge business connections under the breathtaking desert sky. That's precisely what our attendees experienced at the recent HVBA Benefit Networking Roadshow. Despite a rare desert rain deluge, the spirits remained high as professionals enjoyed a memorable evening filled with powerful networking, an open bar, and delicious food, all set against the stunning backdrop of Arizona’s unique landscape. Jake Velie, Vice Chairman and President of HVBA, emphasized the efficiency and power of such gatherings in fostering innovative solutions and partnerships. Don't miss out on the chance to be part of these unparalleled networking experiences. #NetworkingGoals #DesertReception"

  3. Looking Forward - Next Stop: Dallas, TX Join Us on Our Journey🚀: After a successful stint under the Arizona sky, where professionals from the benefits industry connected, learned, and enjoyed unforgettable moments, we're excited to announce Dallas, TX, as our next destination this June. The Benefit Networking Roadshow continues to be a beacon for prospecting, knowledge sharing, and creating business connections. Special thanks to our sponsors, Board of Advisors, and every attendee who made the event a phenomenal success. Stay tuned for more details, and prepare to experience the best in professional networking and educational opportunities.

HVBA Poll Question - Please share your insights

What is your opinion on RWJBarnabas' decision to drop coverage for GPL-1 medications for weight loss among employees, as reported in the article referenced below?*

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 believe PBM practices like spread pricing and increasing hidden fees” is the primary factor contributing to the average 20% increase in pharmacy costs as a percentage of total medical spending for businesses. 

25.13% of respondents believe the primary factor for the increase in pharmacy costs is due to “higher utilization of specialty medications and a lack of resources for discounts on specialty medication,” 23.74% believe it’s due to “increased utilization of prescription drugs,” while 23.49% responded that “rising medication prices” is the main factor. 

Have a poll question you’d like to suggest? Let us know!

Biden's $7.3 trillion budget: 16 healthcare takeaways

By Madeline Ashley, Kelly Gooch and Alexis Kayser - President Joe Biden proposed a $7.3 trillion budget March 11, including various initiatives to lower healthcare costs and an $800 million investment in hospital cybersecurity protection. Read Full Article…

VBA Article Summary

  1. Medicare Enhancements: The proposed budget aims to indefinitely extend the solvency of the Medicare hospital insurance trust fund, projected to be depleted by 2031, through measures such as increasing the Medicare tax rate for individuals earning over $400,000 and redirecting Net Investment Income Tax revenue to the trust fund. Additionally, it seeks to lower drug prices by enabling Medicare to negotiate prices for some of the most expensive and widely used drugs, and caps Medicare Part D cost-sharing for certain generic drugs at $2 per month for beneficiaries.

  2. Medicaid Expansion and Improvement: A significant portion of the budget, $150 billion over ten years, is allocated to enhance and expand Medicaid home and community-based services. It also aims to make permanent the expanded premium tax credits introduced by the Inflation Reduction Act and offers "Medicaid-like coverage" to people in states that have not expanded Medicaid. Furthermore, it proposes eliminating enrollment fees and premiums in the Children's Health Insurance Program to improve access to healthcare for children.

  3. Addressing the Opioid Crisis and Mental Health: The budget requests $1.6 billion in supplemental funding for 2024 to expand substance use prevention, treatment, harm reduction, and recovery support services to combat the opioid overdose epidemic. It also increases funding for the State Opioid Response grant program and introduces a new technical assistance center focused on women's mental health and substance use treatment. This aligns with broader mental health initiatives, including significant investments in mental health services for students and suicide prevention efforts, reflecting a comprehensive approach to public health and wellbeing.

Study Shows Gen Z Employees Not Taking Advantage of Health Savings Accounts

By Remy Samuels - Many Generation Z employees with access to a health savings account are not using them to their full potential or are not contributing to them at all, according to new data from Inspira Financial. Read Full Article…

VBA Article Summary

  1. Low HSA Contribution Among Young Professionals: Despite their focus on mental and physical well-being, nearly one-third of employees under 30 contribute nothing annually to their Health Savings Account (HSA), with only 14% contributing more than $3,000. This is the lowest contribution rate among all generations, as highlighted in Inspira's analysis of over 700,000 HSA holders from January to September 2023. Factors contributing to this trend include lower earnings due to being early in their careers, high medical and living expenses, and a lack of awareness about the necessity for co-payments at medical appointments.

  2. High Medical Costs and Mental Health Challenges: Gen Z employees face higher medical costs compared to peers, alongside managing expenses like car payments, student loans, and possibly mortgages. This financial strain comes at a time of rising levels of anxiety, depression, and overall distress among young people. A significant portion of these medical costs are for chronic conditions, often behavioral health issues, challenging the misconception that young adults are "invincible." This situation is exacerbated by a lack of proactive care-seeking behavior, attributed to various factors including stigma associated with mental health and substance abuse disorders.

  3. Benefits of HSAs and the Importance of Financial Education: Inspira's report suggests that educating young employees about the financial advantages of HSAs, such as their triple tax benefit, and the strategic allocation of savings could improve their long-term financial and health outcomes. Additionally, HSAs offer flexibility by moving with employees across jobs, appealing to the younger workforce likely to change jobs frequently. Emphasizing the importance of preventative care and making informed savings contributions could help mitigate future health care costs and stress on the health care system, especially as medical plan costs are expected to rise.

Telehealth Across State Lines

By American Institute of Healthcare Compliance - When telehealth is used, it is considered to be rendered at the physical location of the patient, and therefore a provider typically needs to be licensed in the patient’s state. Read Full Article…

VBA Article Summary

  1. Interstate Compacts and Licensing Challenges: To alleviate the burden on healthcare providers needing licensure in multiple states for telehealth practices, several states have adopted interstate compacts. These compacts allow providers to offer services in states where they are not licensed, provided they have a valid license in their home state. This approach is suggested due to the impracticality for most providers of obtaining licenses in every state, despite it being the "simplest" solution for universal care provision, as noted by the Center for Connected Health Policy (CCHP).

  2. Post-Pandemic Regulatory Reversions: Following the COVID-19 Public Health Emergency, a report by the Pacific Legal Foundation highlighted that in 30 states, the use of telehealth services with out-of-state doctors has become restricted. This shift marks a rollback of the telehealth access expansions granted during the pandemic, with many states returning to pre-pandemic restrictions, as early legislative and medical board actions since 2021 have reduced telehealth accessibility.

  3. 2024 State Policy Agenda for Telehealth Innovation: The Cicero Institute's publication of the third annual telehealth innovation report provides a comprehensive evaluation of state policies regarding telemedicine across state lines. Utilizing a straightforward stoplight rating system, the report assesses each state's alignment with best practices in telehealth innovation. Additionally, the CCHP’s Telehealth Policy Finder is a valuable resource for reviewing all laws and policies affecting telehealth both at the state and federal levels, tracking six licensure compacts critical for understanding professional requirements in the evolving landscape of telehealth.

How Marketing Fueled the Opioid Overdose Crisis and What We Can Learn From It

By Suzette Glasner-Edwards - The recent series of settlements linked with claims against advertising and pharmaceutical manufacturing companies involved in the sales and marketing of opioid drugs are encouraging, demanding accountability for promoting highly addictive drugs such as OxyContin as non-addictive. Read Full Article…

VBA Article Summary

  1. Significant Settlements Offer Hope but Raise Questions: Recent settlements ranging from $350 to $465 million are seen as a beacon of hope for individuals dealing with opioid use disorders, especially since they include funding for treatment. However, the effectiveness of these criminal and civil suit settlements in combating the opioid overdose epidemic is uncertain. Despite previous lawsuits, opioid marketing practices have largely remained unchanged, leading to ongoing issues with addiction recognition and the overprescription of addictive medications.

  2. The Influential Role of Marketing in the Opioid Crisis: The opioid crisis, exacerbated by aggressive pharmaceutical marketing since the 1990s, has significantly contributed to the surge in opioid prescriptions and related overdose deaths, which exceeded 106,000 in 2021. Misinformation about the safety of long-term opioid use, the underplayed risk of addiction in marketing materials, and financial incentives for prescribers have undermined the healthcare system's response to non-cancer-related pain management. Studies indicate a direct correlation between the extent of opioid marketing to physicians and the subsequent rise in overdose deaths.

  3. Strategies to Counteract the Negative Impact of Opioid Marketing: Despite the punitive measures against companies like Purdue Pharma, competitors have aggressively increased their marketing efforts, raising concerns about the repetition of history. To mitigate the crisis, it is crucial to educate licensed prescribers on addiction risk assessment and management, improve detection and treatment of addiction, and reevaluate policies on pharmaceutical marketing. Implementing recommendations from the Institute of Medicine to reduce advertising's impact on prescribing practices is a critical step towards preserving public trust in the medical profession and preventing future drug crises.

UnitedHealth Group expects mid-March recovery for systems affected by cyberattack

By Christopher Snowbeck - UnitedHealth Group is reporting progress on restoring systems affected by a cyberattack last month that snarled pharmacies and blocked claims processing at hospitals and clinics nationwide. Read Full Article…

VBA Article Summary

  1. Cyberattack on UnitedHealth Group's Change Healthcare: UnitedHealth Group's Change Healthcare subsidiary has been significantly impacted by a cyberattack since February 21, leading to a suspension of operations. This attack, attributed to the cybercrime group ALPHV/Blackcat, has disrupted electronic data clearinghouse operations, affecting the processing of medical claims across the U.S. UnitedHealth is actively working on restoring systems, with electronic prescribing now functional and a timeline set for re-establishing connections to its claims network by March 18.

  2. Financial Relief and Operational Adjustments: In response to the cyberattack's fallout, UnitedHealth announced improvements to its financial relief program for health care providers, addressing criticisms about previous aid insufficiencies. The company is temporarily suspending prior authorizations and utilization reviews for its Medicare Advantage plans to expedite reimbursements. These measures aim to mitigate financial strains on providers who have faced difficulties in submitting claims and receiving payments, potentially affecting their operations and patient care.

  3. Continuing Challenges and Industry Response: The health care sector is facing significant challenges due to the attack, with delayed claims submissions and payments putting financial pressure on hospitals and clinics. Health care providers express concerns over operational sustainability amidst these delays, with the Minnesota Hospital Association highlighting the severe administrative and financial burdens imposed on the industry. While UnitedHealth's efforts to restore services and provide financial relief are acknowledged, the broader implications of the attack underscore the vulnerability of the health care system to cyber threats and the critical need for robust cybersecurity measures.

Louisiana lawmakers look to make a future BCBS sale more difficult 

By Jakob Emerson - Three weeks after a halted merger between BCBS Louisiana and Elevance Health, two Louisiana state lawmakers have filed bills that would make it more difficult for nonprofit insurers, (such as BCBS Louisiana) to reorganize into a for-profit organization that could then be sold, nola.com reported March 5. Read Full Article…

VBA Article Summary

  1. Pause on Acquisition by Elevance Health: BCBS Louisiana put its acquisition plans by Elevance Health on hold for a second time in February, after facing significant scrutiny from physicians, hospitals, and state officials. This decision followed an initial halt in September, prompted by concerns from the state's attorney general and lawmakers.

  2. Legislative Response to Concerns: In response to the issues raised regarding the sale, newly proposed bills, though not naming BCBS Louisiana explicitly, aim to enforce stricter regulations. These include mandates for additional financial transparency and sales analysis, prohibiting insurance board directors from receiving sale proceeds, banning the acquisition of proxy votes from members via phone, and requiring state approval for advertising potential sales.

  3. Safeguards for Future Transactions: The proposed legislation is designed to protect against the problems of information access and vote manipulation that were highlighted by the BCBS deal, according to State Sen. Patrick McMath. BCBS responded to the proposed bills, stating their intent to review and engage with all proposed legislation to ensure any changes benefit the Louisiana health insurance market and its stakeholders.

GOP leaders demand answers from Medicare on alleged $2B catheter fraud

By Dan Diamond - House Republicans on Wednesday demanded that federal health officials address an alleged Medicare fraud ring estimated at more than $2 billion. Health-care groups warn that the scheme has ensnared hundreds of thousands of patients and continues to expand. Read Full Article…

VBA Article Summary

  1. Massive Surge in Fraudulent Medicare Claims: Investigations and documents reveal that at least 10 companies are implicated in a dramatic increase in Medicare claims for urinary catheters, with no corresponding change in clinical practices or device usage. The National Association of ACOs identified about $2.8 billion in fraudulent claims in a single year, a significant jump from the $150 million annually billed previously for these devices, implicating the data of over 400,000 patients.

  2. Government and Law Enforcement Response: The alarming scale of the fraud prompted urgent calls for action from various congressional leaders and health officials. The Department of Health and Human Services, along with the Centers for Medicare and Medicaid Services, has been questioned about their detection and prevention measures. Meanwhile, the FBI and other agencies are conducting investigations, but details remain limited due to standard policy. HHS Secretary Xavier Becerra confirmed an active federal review is underway.

  3. Efforts to Combat and Prevent Further Fraud: In response to the fraudulent activities, the Health and Human Services inspector general’s office issued a consumer alert warning Medicare enrollees about scam tactics. CMS has implemented measures to prevent fraudulent claims from being paid and suspended some companies from receiving payments. Lawmakers from both parties have expressed concern over the vulnerability of seniors to such frauds and are advocating for stronger measures, including the use of data analytics to detect unusual billing patterns, to safeguard the integrity of Medicare funds and protect beneficiaries.

Ascension Health, a big chain of Catholic hospitals, claims to advocate for a compassionate and just society. But its business practices and investments tell a different story.

By Chris Deacon - News recently broke that New Mountain Capital has sought to acquire outstanding shares of R1, a revenue cycle management firm, according to SEC Filings. New Mountain seeks to acquire all outstanding shares not currently owned by investors at $13.75 per share, equating to about $5.8 billion. Read Full Article…

VBA Article Summary

  1. Engagement with TPC-ASC: R1 leadership is actively seeking to engage New Mountain Capital in good faith discussions with TCP-ASC, an investment entity jointly owned by Ascension Health Alliance and TowerBrook Capital Partners. This move is not solely based on financial strategies but also raises concerns due to R1's controversial business practices, such as their "Propensity to Pay Algorithm," which uses various data inputs to prioritize patient payments and improve cash flow. This system, while common in revenue cycle management, highlights the ethical considerations in patient treatment and financial management within the healthcare sector.

  2. Background of TPC-ASC: The partnership between Ascension, one of the largest Catholic hospital systems in the U.S., and TowerBrook Capital Partners began around 2015 with an investment in Accretive Health, a debt collection company facing severe legal and financial difficulties. This partnership marked the beginning of a series of aggressive financial maneuvers, including turning internal non-profit departments into profitable entities, under the guise of supporting Ascension's mission. The narrative of rescuing financially distressed companies contrasts starkly with the handling of financially distressed patients, revealing a complex interplay of ethics, profit, and healthcare.

  3. Ascension's Venture Capital Activities: Ascension's active participation in venture capital, through Ascension Ventures and other investments, underscores a broader trend of non-profit hospitals leveraging their resources, research, and intellectual property to generate significant profits. This strategy, facilitated by IRS rulings and other legal frameworks, allows for-profit ventures to emerge from non-profit entities, raising questions about the true mission and values of such organizations. Despite assurances from Ascension leadership about their commitment to serving the poor and vulnerable, the financial and ethical implications of these investments, especially in light of their involvement with R1 and TPC-ASC, suggest a more complex narrative about the priorities and impacts of such healthcare giants.