Price Transparency: Private plans pay more, a lot more

By Marie Defreitas - A new report published by RAND found that during 2022 private insurers paid hospitals on average 254% of what Medicare would have paid for both inpatient and outpatient services. Read Full Article…

HVBA Article Summary

1. Price Disparities Persist: Despite efforts to address healthcare price transparency, a RAND report reveals that private health plans continue to pay hospitals significantly more than Medicare. In 2022, prices for various medical services averaged 200% higher for private insurers compared to Medicare rates, with variations across states indicating a lack of uniformity.

2. Impact on Affordability: The inflated prices contribute to medical debt and higher costs for employers providing health plans. With private health insurance covering approximately 160 million Americans, these disparities serve as significant drivers of per capita spending, exacerbating affordability challenges in the healthcare system.

3. Necessity of Collaboration: To address this issue effectively, collaboration between private insurers and employers is essential. While federal policies mandate price transparency, compliance remains an issue, compounded by challenges such as data accuracy and accessibility. Insurers and employers must work together to create well-structured plans grounded in accurate data, fostering a more transparent and equitable healthcare landscape.

Dealing with Stress, Burnout in the HR, Benefits Department

By Remy Samuels - As staff members in the HR and benefits department often wear multiple hats, from overseeing an organization’s retirement plan to managing a company’s health care benefits, it is easy for these workers to feel overwhelmed, stressed and burnt out at times. Read Full Article…

HVBA Article Summary

1. Understanding HR Stressors: A survey by HR Executive revealed that 76% of HR leaders experienced increased stress in 2023, primarily due to the pressure of "doing more with less." This stress stems from heavier workloads without corresponding increases in staffing or resources, highlighting the challenges faced by HR professionals.

2. Operational Challenges: Rachel Huber Christman, director of total rewards at the Alaska Native Tribal Health Consortium, shares insights into the operational challenges within her organization's benefits department. Transitioning from paper-based to online enrollment systems has improved efficiency and reduced administrative burdens. However, maintaining work-life balance remains crucial, with Christman emphasizing the importance of proactive employee engagement and encouraging team members to take adequate time off to prevent burnout.

3. Clarifying Fiduciary Responsibilities: Christman underscores the importance of delineating fiduciary responsibilities within the organization. She emphasizes the need to avoid blurring the line of fiduciary responsibility with team members to prevent potential personal liability. Clear descriptions of fiduciary duties in appointing resolutions and plan documents, as recommended by T. Rowe Price's "Fiduciary Guide," help mitigate confusion and ensure accountability in plan management and administrative activities.

Hospital price transparency data can be a game changer for self-funded employers

By Deanna Cuadra - Many employers feel like they're grasping at straws when it comes to lowering healthcare costs — but a means of saving may just be in reach.The Hospital Price Transparency Final Rule and the Transparency In Coverage Final Rule, effective in 2021 and 2022 respectfully, require hospitals to publish previously private rates for their services. Read Full Article…

HVBA Article Summary

1. Empowering Employers with Data: Transparency in coverage provides employers, especially those with self-funded plans, with detailed insights into negotiated rates between hospitals and carriers. This data empowers employers to identify providers and hospitals offering optimal value, potentially leading to significant cost savings of up to 27% across common healthcare services, according to Turquoise Health.

2. Challenges in Adoption: Despite the potential benefits, employers may be hesitant to transition from traditional methods of evaluating provider networks, such as examining claims data. One significant hurdle is the complexity of the price transparency data itself, which can be challenging to interpret without specialized expertise. Without dedicated data scientists, many smaller employers may struggle to leverage this valuable information effectively.

3. Taking Action for Cost Efficiency: While the evolution of transparency rules may eventually lead to more standardized and accessible data, waiting for these changes is not advisable. Employers are encouraged to proactively engage with the available data, whether by hiring data experts, seeking guidance from platforms like Turquoise Health, or adjusting priorities within their benefits teams. By analyzing reimbursement rates for procedures and identifying instances of overcharging, employers can optimize their healthcare plans, negotiate better deals with carriers, and ultimately ensure their employees receive the best possible care at an affordable cost.

CVS CEO to Wall Street: People in Medicare Advantage Are in for a World of Hurt as We Focus on Profits

By Wendell Potter - If you are enrolled in an Aetna Medicare Advantage plan, now might be a good time to get more nervous than usual. Wall Street is not happy with Aetna’s parent, CVS Health. In response to that unhappiness, triggered by the company’s admission that it has been paying more claims than usual, CVS execs have promised to do whatever it takes to get profit margins back to a level investors deem suitable. Read Full Article…

HVBA Article Summary

1. Increased Odds of Coverage Denials: With the recent developments, there's a heightened probability that Aetna will deny coverage for essential treatments and medications prescribed by your doctor. This shift could potentially leave policyholders grappling with out-of-pocket expenses and limited healthcare options.

2. Rising Premiums and Potential Policy Termination: CVS/Aetna's response to financial pressures includes likely premium increases for the upcoming year and the possibility of discontinuing coverage altogether for certain policyholders. This pattern mirrors past instances where Aetna has opted to drop health plan enrollees perceived as financially burdensome.

3. Industry Challenges and Strategic Adjustments: Medicare Advantage companies, including CVS/Aetna, are navigating significant challenges, ranging from increased Congressional scrutiny to regulatory changes and enrollee dissatisfaction. The company's strategic response involves adjusting benefit structures, potentially exiting certain service counties, and closely monitoring competitor actions to maintain profitability and satisfy shareholders.

Millennials, Gen Z twice as likely to get financial advice online, study finds

By Rayne Morgan - Financial professionals should leverage social media to connect with millennials and Gen Z, as new research indicates they are twice as likely to get financial advice online than from a professional, says financial counselor Myles Ma. Read Full Article…

HVBA Article Summary

1. Social Media Influence: Younger generations, particularly millennials and Gen Z, are heavily influenced by social media trends in finance, with 62% having tried various "financial hack" trends. Advisors should recognize this trend and leverage platforms like Instagram, YouTube, and TikTok to provide accessible financial education and advice tailored to these demographics.

2. Preference for Non-Traditional Investments: Millennials and Gen Z demonstrate a greater willingness to explore non-traditional avenues to wealth, such as cryptocurrencies and "infinite banking," compared to older generations. Advisors need to acknowledge and address this preference by providing comprehensive education on both traditional and novel investment options, emphasizing the risks associated with newer forms of investment.

3. Unique Economic Challenges: Younger generations face distinct economic challenges, including a housing shortage and stagnant wages, hindering their ability to accumulate wealth compared to previous generations. Advisors should be attuned to these challenges and offer tailored guidance and support, addressing the specific financial concerns and insecurities of millennials and Gen Z to foster confidence and effective financial management.

Healthcare’s Next Void to Fill: Digital Primary Care

By Ed Liebowitz - The rapid rise of digital healthcare has placed the industry in a transformative phase, and one thing is needed to seize this opportunity and improve access to care successfully: accountability. Read Full Article…

HVBA Article Summary

1. Rise of Digital Care: With over 90 percent of health systems adopting telehealth programs and a significant expansion in offerings over the past year, digital care has entered the mainstream. However, the proliferation of digital health programs poses a new challenge of trust and navigation, especially for chronic and specialty conditions.

2. Revolutionizing Specialty Care: Virtual specialty care addresses barriers faced by patients in accessing specialists, such as appointment availability, work constraints, transportation issues, and geographical limitations. By connecting patients with physicians virtually, it enhances access, convenience, and reduces costs, ultimately improving patient satisfaction and outcomes.

3. Need for Digital Guidance: As virtual specialty care gains traction, the absence of traditional primary care provider roles in digital settings leaves patients without trusted guidance. Employers and health plans can fill this void by offering personalized navigation experiences, leveraging AI-driven solutions to provide guidance, support, and personalized care, ultimately placing the patient at the center of their healthcare journey.

US Cyber Insurance Sustains Profits, Premium Growth Slows

By Captive.com - According to Fitch Ratings, the US cyber-insurance sector maintained robust direct underwriting profits in 2023 for the second consecutive year. However, growth in written premiums has tapered off amid renewed pricing pressures. Read Full Article…

HVBA Article Summary

1. Stable Underwriting Performance: Despite the challenges faced in 2020 and 2021, the direct incurred loss and defense and cost-containment expenses ratio for stand-alone cyber coverage remained relatively stable at 44 percent in 2023, showcasing a profitable trend averaging 48 percent over the past nine years.

2. Factors Contributing to Profitability: Favorable underwriting results in the cyber insurance market are attributed to factors such as significant premium rate increases, enhanced risk selection and underwriting processes, stricter policy terms, and the implementation of sublimits and exclusions, according to Fitch analysis.

3. Market Dynamics and Challenges: While demand for cyber coverage remains robust, the market witnessed a modest 2 percent decline in US statutory direct written premiums for cyber coverage in 2023, marking the first decrease on record. Stand-alone cyber coverage, which constitutes a significant portion of the industry, experienced a 3 percent decline, indicating potential challenges in sustaining profitability amid flat or decreasing pricing trends. Insurers are urged to maintain underwriting discipline, navigate evolving regulatory requirements, and address the uncertainty surrounding cyber-catastrophe exposure and risk modeling.

Physical Activity Helps Ward Off Inflammatory Bowel Disease, Meta-Analysis Shows

By Manasi Talwadekar - Higher levels of physical activity are associated with a decreased risk of developing inflammatory bowel disease (IBD), particularly Crohn's disease (CD). Read Full Article…

HVBA Article Summary

1. Systematic Review and Meta-analysis Approach: Researchers conducted a systematic review and meta-analysis to evaluate the relationship between physical activity and inflammatory bowel disease (IBD) risk. They analyzed data from three large population-based cohort studies and seven case-control studies, encompassing a diverse range of global regions and published before April 2023.

2. Impact of Physical Activity on IBD Risk: High physical activity levels were associated with a significant reduction in the risk of developing Crohn's disease (CD) and ulcerative colitis (UC). In cohort studies, individuals with high physical activity levels exhibited a 22% reduced risk of CD and a 13% reduced risk of UC. In case-control studies, the risk reduction for CD was even more pronounced at 38%, although the reduction in UC risk did not reach statistical significance.

3. Quality of Evidence and Implications for Practice: The quality-of-evidence assessment revealed no serious limitations in the cohort studies but identified significant limitations in the case-control studies due to biases and heterogeneity. Despite this, the findings suggest a potential role for physical activity as a preventive strategy against IBD development. Authors advocate for public health interventions promoting physical activity and suggest physicians consider advising increased physical activity levels, particularly for individuals at high risk of IBD, such as those with a strong family history of the disease.

Drug patents protect pharma profits. Track when they’ll expire here.

By Jonathan Gardner - Patents reward drugmakers for their inventions and, effectively, the large sums of money they invest in research and development. The legal monopoly that patents provide keeps generic copies at bay for many years, even decades, and allows pharmaceutical companies to set higher prices than they otherwise could. Read Full Article…

HVBA Article Summary

1. Strategic Investment in R&D vs. Acquisition: With a looming patent cliff threatening over $200 billion in annual revenue, pharmaceutical companies face critical decisions. They must weigh the option of allocating resources towards research and development to replenish their pipelines or opt for acquisition strategies to navigate through impending patent expirations. These decisions will significantly influence their competitive positions and market longevity.

2. Complex Patent Strategies: Amidst patent expirations, pharmaceutical companies employ multifaceted strategies to prolong market exclusivity. Beyond standard 20-year patent terms, they utilize regulatory exclusivity, patent term restoration, and intricate patent thickets encompassing various aspects from dosing schedules to delivery mechanisms. These strategies aim to fend off generic competition and extend market monopoly for decades, exemplified by cases like Amgen's Enbrel enjoying over 30 years of protection.

3. Data-Driven Decision Making: BioPharma Dive's database, compiled from regulatory filings, offers insights into the expiration dates of principal patents safeguarding the top 30 pharmaceutical products. While not exhaustive, it provides valuable foresight into the timing of market competition due to primary patent expirations. Additionally, it underscores the significance of ongoing updates to account for regulatory extensions, court rulings, and other events that influence market exclusivity.

If at First Tirzepatide Doesn't Succeed, Keep Trying

By Miriam E. Tucker - When using tirzepatide (Zepbound, Eli Lilly) to treat obesity, patience may pay off. New post hoc data from Lilly's SURMOUNT-1 trial of people with overweight or obesity but not diabetes suggest that the drug will almost always produce at least 5% weight loss eventually, even among slow responders. Read Full Article…

HVBA Article Summary

1. Extended Treatment Duration: Some obesity treatment guidelines advocate for prolonging the administration of anti-obesity medication (AOM) beyond the conventional 12-week period, especially for newer medications like tirzepatide. This extension is justified by the gradual titration schedule of tirzepatide, which may take up to 20 weeks to reach the highest effective dose.

2. Response Variability and Titration: Analysis revealed that individuals who initially showed slow weight loss response to tirzepatide, termed "slow responders," eventually achieved significant weight reduction, with 90% reaching at least 5% body weight loss by week 72. This response underscores the importance of patient persistence and the necessity for titrating tirzepatide doses to ensure tolerability and efficacy.

3. Individualized Approach: Clinical management should be tailored to individual responses. While some patients may exhibit delayed but ultimately successful weight loss outcomes, others may not respond adequately even after dose titration. A personalized approach involves ongoing assessment of response, with consideration given to discontinuing medication if there's no response after six months, or exploring alternative treatment options. Further research is warranted to elucidate factors contributing to the variability in weight loss response to tirzepatide.