Daily Industry Report - March 28

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)

Medicare’s GLP-1 spending is skyrocketing, even without weight loss coverage: KFF

By Rebecca Pifer - Medicare spending on pricey GLP-1 drugs like Ozempic has skyrocketed in recent years, and expanding the insurance program’s coverage of the drugs — like for weight loss — could cause spending to accelerate even more drastically, according to a new report. Read Full Article…

VBA Article Summary

  1. Exponential Growth in Medicare Spending: Gross Medicare spending on GLP-1s has surged dramatically, skyrocketing from $57 million in 2018 to a staggering $5.7 billion in 2022, as revealed by a KFF analysis of government data. This tenfold increase underscores a significant financial burden on the Medicare program within just a few years.

  2. Rising Demand and Expensive Medications: GLP-1s, initially developed to treat diabetes, have witnessed a surge in demand due to their efficacy in weight management and reducing cardiovascular risks. However, their high costs, with annual list prices exceeding $11,000, pose financial challenges for employers, insurers, and medical coverage sponsors, exacerbating the strain on healthcare budgets.

  3. Implications for Medicare and Potential Solutions: Medicare's coverage of GLP-1s under Part D has already made a substantial impact on program spending, with Ozempic alone constituting 2% of all Part D spending in 2022. While legislation is proposed to expand coverage to weight loss drugs, concerns linger about the financial sustainability of Medicare. Without cost control measures or negotiation strategies, the escalating demand, expanding indications, and exorbitant prices of GLP-1s are poised to intensify pressure on Medicare spending, Part D plan costs, and premiums, potentially pushing the program closer to insolvency.

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!

New Transparent AI Predicts Breast Cancer 5 Years Out

By Lisa Marshall - A new way of using artificial intelligence (AI) can predict breast cancer 5 years in advance with impressive accuracy — and unlike previous AI models, we know how this one works. Read Full Article…

VBA Article Summary

  1. Simplified Predictive Model: The newly developed AI system, AsymMirai, focuses on comparing differences between right and left breasts to predict breast cancer risk. This simplified approach enhances transparency and trust in decision-making, allowing users to understand and validate the algorithm's outputs, potentially leading to better patient outcomes.

  2. Clinical Impact and Potential Benefits: AsymMirai has the potential to revolutionize breast cancer risk assessment by saving lives, reducing unnecessary testing, and cutting healthcare costs. By accurately identifying high-risk individuals, clinicians can tailor personalized screening strategies, recommending more frequent screenings or supplementary tests like MRI for those with elevated risk, while sparing low-risk patients from unnecessary exams.

  3. Future Implications and Challenges: While AsymMirai shows promising results in predicting breast cancer risk, cautious optimism prevails due to the complex landscape of AI integration in healthcare. Despite advancements, challenges such as reluctance from clinicians and patients to solely rely on AI for medical decisions persist. Continued refinement of AI models and careful integration into clinical practice are essential steps towards maximizing their potential to improve patient care and outcomes.

Steward to sell physician group to UnitedHealth’s Optum Care

By Susanna Vogel - Steward has been hit with escalating allegations of financial and operational mismanagement in recent months, including falling so behind on debts to vendors that critical medical equipment is routinely repossessed. Read Full Article…

VBA Article Summary

  1. Acquisition by UnitedHealth Group: Steward Health Care has agreed to sell its physician network, Stewardship Health, to UnitedHealth Group's subsidiary, Optum Care. This acquisition encompasses Steward's nine-state network of primary care providers and clinicians, raising concerns among stakeholders about the potential impact on healthcare costs, quality, and access.

  2. Antitrust and Regulatory Scrutiny: The proposed deal has sparked concerns about reduced competition in Massachusetts' healthcare market and antitrust violations, especially given UnitedHealth's already significant physician network. Senior Massachusetts officials and Senator Elizabeth Warren have raised red flags about the deal's potential anticompetitive effects and its implications for patient-centered care.

  3. Complexities and Financial Risks: The deal faces additional complexities, including the possibility of regulatory intervention and challenges stemming from Steward's financial health. With pending lawsuits and indications of insolvency, there are concerns that Steward's assets, including Stewardship Health, could be at risk of being reclaimed in the event of bankruptcy proceedings, adding further uncertainty to the transaction's outcome.

Physician Shortage Smaller Than Previously Expected, Report Shows

By Jennifer Henderson - New projections pointed to a significant shortage of physicians in the next 10 to 15 years, albeit one smaller than previously anticipated, according to a report from the Association of American Medical Colleges (AAMC). Read Full Article…

VBA Article Summary

  1. Projected Physician Shortages: By 2036, a shortage of physicians in the range of 13,500 to 86,000 is anticipated due to growing demand outpacing supply. This projection hinges on continued investment in graduate medical education, with funding increases from health systems, states, and the federal government potentially mitigating the gap.

  2. Impact on Specialties: Primary care faces a significant shortfall, with projections indicating a shortage of 20,200 to 40,400 physicians by 2036. Surgical specialties are also affected, with an anticipated shortage of 10,100 to 19,900 physicians, while medical specialties show a range from a deficit of 5,500 to a surplus of 3,700 physicians.

  3. Drivers of Demand and Future Considerations: Demographic shifts, such as population growth and aging, are major contributors to increased demand for physicians. Notably, potential shortages could be exacerbated if underserved populations adopt healthcare patterns similar to those with fewer access barriers. Additionally, areas ripe for further study include the impacts of COVID-19, workforce diversity, the role of advanced practice registered nurses (APRNs) and physician assistants (PAs), and understanding current shortages across specialties and geographic distribution.

73% of workers would jump ship for better family benefits

By Joel Kranc - Four in 5 nonprofit hospitals are spending less on community benefit areas like financial assistance than what they are estimated to receive in tax breaks, according to the latest annual report from the Lown Institute looking at 2021 IRS filings. Read Full Article…

VBA Article Summary

  1. Widespread Dissatisfaction and Benefit Ratings: The survey highlights a concerning trend, with 62% of employees expressing dissatisfaction with their employer's family-friendly policies. Alarmingly, 43% of respondents rated their current benefits as "C" or lower, indicating a significant gap in meeting employee needs.

  2. The "Great Benefits Exodus": A staggering 73% of surveyed employees express a willingness to leave their current job for better family benefits. This phenomenon underscores the importance of family-friendly policies in retaining talent and suggests a looming exodus if employers fail to adapt.

  3. Critical Coverage Gaps and Shifting Priorities: The report uncovers critical gaps in support for women's health and alternative family planning. Despite 83% of women reporting that perimenopause and menopause symptoms impact their work, a mere 1% receive workplace support. Moreover, the survey reveals a mismatch between demand and availability in areas such as pregnancy loss support (5%) and alternative family planning options like adoption, surrogacy, and foster support (ranging from 5% to 38%). This underscores the evolving expectations of the contemporary workforce and the need for employers to prioritize benefits like longer parental leave and flexible scheduling, which 82% and 81% of respondents, respectively, consider crucial.

Will hospitals need to notify patients about the Change hack?

By Jakob Emerson - Following the Change Healthcare cyberattack in February, questions remain around what data may have been stolen and how patients would be notified if needed — the issue is top of mind for hospitals nationwide. Read Full Article…

VBA Article Summary

  1. Investigation by HHS: On March 13, the Department of Health and Human Services (HHS) initiated an investigation into UnitedHealth Group and Change Healthcare concerning a cyberattack, focusing on HIPAA compliance. The investigation is not targeting providers or payers associated with Change Healthcare. HHS emphasized the importance of adhering to regulatory obligations, such as having business associate agreements in place and ensuring timely breach notifications to both HHS and affected individuals as mandated by HIPAA Rules.

  2. AHA's Request for Clarification: The American Hospital Association (AHA) reached out to HHS on March 21, seeking clarification on whether hospitals and health systems are required to notify patients about potential compromises to their protected health information. The AHA expressed concerns about the possibility of being mandated to issue breach notifications if it's later found that a breach occurred. They argued that Change Healthcare, as a covered entity, should be responsible for notifying affected individuals and the Office for Civil Rights (OCR), advocating for a unified notification process to avoid patient confusion and unnecessary costs for hospitals already impacted by the cyberattack.

  3. State-level Reminders and Change Healthcare's Acknowledgment: The Washington State Hospital Association advised hospitals about state-level data breach notification laws, highlighting the need to review obligations under business associate agreements (BAAs), which include aspects like breach notification timing and indemnification. Change Healthcare confirmed that the ransomware group ALPHV/BlackCat claimed responsibility for the attack, alleging the theft of 6 terabytes of sensitive data, including medical records and Social Security numbers. However, Change Healthcare has yet to confirm if protected health information was compromised in the attack, while ransomware groups often overstate data theft to negotiate higher ransoms.

Baltimore bridge collapse could affect medical supply chain

By Ron Southwick - With the collapse of the Francis Scott Key Bridge in Baltimore affecting the Port of Baltimore, the delivery of drugs and medical supplies could be affected. Read Full Article…

VBA Article Summary

  1. Disruption to Medical Supplies Shipment: The collapse of the Francis Scott Bridge following a cargo ship collision at the Port of Baltimore has raised concerns about potential delays in the shipment of crucial medical supplies. Healthcare leaders warn that while the extent of the impact remains uncertain, disruptions in port operations could persist for an extended period, potentially affecting healthcare providers' access to essential supplies.

  2. Supply Chain Challenges and Lack of Visibility: The closure of the Port of Baltimore poses challenges to the healthcare supply chain, exacerbated by a lack of visibility into the specific products and manufacturers affected by the disruption. With uncertainty surrounding the timeline for resuming normal port operations, healthcare organizations face difficulties in assessing the full extent of supply chain disruptions and mitigating their impact on patient care.

  3. Implications for Truck Traffic and Regional Supply Distribution: Beyond maritime shipments, the collapse of the Francis Scott Bridge disrupts truck traffic essential for delivering medical supplies across the Baltimore region. With thousands of vehicles now seeking alternative routes, healthcare providers anticipate logistical challenges and potential delays in supply distribution, underscoring the need for enhanced resilience and adaptability in healthcare supply chain management strategies.

CBO weighs in on PBM reform, AI in healthcare

By Paige Minemyer - The Congressional Budget Office (CBO) addressed a series of questions from lawmakers on health policy priorities ranging from pharmacy benefit management to Medicare spending. Read Full Article…

VBA Article Summary

  1. Mixed Results in AI and ML Implementation: The Congressional Budget Office (CBO) highlights the potential of artificial intelligence (AI) and machine learning (ML) in healthcare, citing applications such as patient intervention prioritization and disease detection. However, while AI showed promise in predicting mortality in oncology, its efficacy in predicting heart failure outcomes was less impressive, indicating a varied landscape of successes and failures in current research.

  2. Potential Cost Reductions through PBM Reforms: CBO discusses the potential fiscal benefits of proposed reforms to Pharmacy Benefit Managers (PBMs), such as banning spread pricing in Medicaid and mandating community pharmacy participation in acquisition cost studies. These measures are estimated to save the federal government $1.1 billion between 2024 and 2033, facilitating better understanding and negotiation of PBM practices, ultimately leading to reduced federal spending.

  3. Revision of Past Overestimations and Ongoing Monitoring: Acknowledging past errors, CBO emphasizes its commitment to accurate analysis and ongoing evaluation of healthcare policies. Notably, it admits to significantly overestimating the cost of Medicare Part D in 2003. Moving forward, CBO pledges to monitor recent legislation, like the Inflation Reduction Act, and provide regular updates to Congress, ensuring informed decision-making based on current data and insights.

21 most innovative health systems, per Fortune

By Molly Gamble - Out of the 200 companies heralded by Fortune as most innovative for 2024, 44 are in healthcare and 21 are health systems. Read Full Article…

VBA Article Summary

  1. Increased Healthcare Representation: The 2024 Fortune 200 list saw a notable rise in healthcare companies compared to the previous year, despite the list being shortened from 300 to 200. This shift underscores the growing significance of healthcare within the business landscape.

  2. Tech Giants' Dominance: Alphabet, Apple, and Microsoft secured the top three spots on this year's list, with Apple making a significant leap to claim the second spot. This dominance highlights the tech industry's ongoing innovation and influence in shaping various sectors.

  3. Innovation Criteria: Fortune's ranking methodology emphasizes three dimensions—product innovation, process innovation, and innovation culture—each weighted equally. This holistic approach considers factors like patent scores, expert opinions, and internal entrepreneurial spirit, reflecting a comprehensive evaluation of companies' transformative impact on industries.

AHA disputes 'biased' hospital charitable contribution report

By Madeline Ashley - The American Hospital Association is defending the community dedication of hospitals and health systems after the Lown Institute, a nonpartisan healthcare think tank, released a report that found charity care from 80% of nonprofit hospitals falls behind tax breaks. Read Full Article…

VBA Article Summary

  1. Expansion of Data: The "fair share spending" report, utilizing 2021 IRS data, analyzed a broader spectrum of hospitals, encompassing 2,425 nonprofit institutions in the U.S., which is a significant increase compared to the previous year. This expansion sheds light on a more comprehensive picture of hospital spending and community investment.

  2. Critique of Report Findings: Rick Pollack, President and CEO of the American Hospital Association (AHA), contested the credibility of the Lown report, highlighting biases and flaws in its methodology. He emphasized the report's oversight of significant areas such as Medicaid and Medicare underpayments, which are crucial financial burdens for hospitals to bear.

  3. Contextual Challenges: Pollack emphasized the challenges hospitals faced during the COVID-19 pandemic, arguing that the report's assessment lacked consideration for the extraordinary circumstances hospitals navigated in 2021. He underscored the complexities of hospital finance, citing unforeseen events like the Change Healthcare cyberattack, and cautioned against implementing standardized financial assistance requirements without accounting for fluctuating fiscal landscapes.