‘The Time Is Now’: How Employers Can Offer Comprehensive Obesity Care

By Marissa Plescia - Obesity rates in the U.S. have been steadily increasing. By 2030, about half of U.S. adults will have obesity. While the obesity crisis isn’t new, what’s new is the availability of effective though expensive drugs like GLP-1s for weight loss. Read Full Article…

HVBA Article Summary

1. Employer Responsibility: With a significant portion of Americans obtaining health insurance through their jobs, employers are under increasing pressure to address obesity treatment demands from their covered employee population. This entails recognizing obesity as a chronic disease and implementing comprehensive strategies to tackle it.

2. Holistic Approach to Treatment: Acknowledging the complexity of obesity and its varied root causes, employers must adopt a holistic approach to weight loss interventions. This includes offering personalized treatment options, such as lifestyle changes, bariatric surgery, and medications like GLP-1s, while also emphasizing education and awareness among employees.

3. Strategic Solutions for Employers: To effectively address the challenges associated with obesity treatment, employers can implement a range of solutions. These include providing educational resources, fostering a supportive workplace culture, incorporating strategic benefit design planning, and advocating for relevant public policies. Additionally, ensuring access to a variety of weight loss medications and promoting participation in comprehensive weight management programs can contribute to improved health outcomes for employees.

Investigations into health care consolidation, profiteering lack necessary insurer angle

By Wendell Potter - In April, my hometown newspaper, The Philadelphia Inquirer, ran an article with a key takeaway that further troubled those of us nervous about consolidation in health care. Citing researchers from the University of California-Berkeley, the Inquirer reported more than 40 percent of urology practices in the Philadelphia area are now private equity-backed. Read Full Article…

HVBA Article Summary

1. Growing Concerns about Health Care Consolidation: The article highlights increasing worries about consolidation in the health care sector, particularly regarding the ownership of physician groups and health care facilities by health insurance companies. This trend, exemplified by Steward Healthcare's attempt to sell its physician group to Optum, a subsidiary of UnitedHealth Group, raises questions about competition and the potential consequences for patients and the health care system as a whole.

2. Overlooked Players in Health Care Consolidation: While private equity's role in health care has received significant scrutiny, the article argues that attention should also be directed towards the consolidation efforts of health insurance companies. Despite less public attention, insurers like UnitedHealth have gained significant control, employing or otherwise controlling roughly ten percent of American doctors, according to the American Medical Association. The article questions whether sufficient regulatory scrutiny has been applied to these entities compared to private equity firms.

3. Shifting Regulatory Focus: The article points out a shift in regulatory focus, with the Department of Justice announcing a task force on "Health Care Monopolies and Collusion" specifically targeting insurer acquisitions and market control. This development signals a potential change in oversight priorities, acknowledging the need to scrutinize not only private equity but also insurers' consolidation efforts in the health care industry.

Increased M&A of U.S. Hospitals Leads to Turnover, Benefits Confusion

By Remy Samuels - With major hospitals increasingly going through mergers and acquisitions, Fidelity Investments found in a recent study that these changes can cause extra stress and worry for health care workers and can lead to higher turnover rates. Read Full Article…

HVBA Article Summary

1. Employee Reconsideration Post M&A: Nearly half of employees express intent to reconsider their employment following a merger or acquisition (M&A), highlighting significant concerns within the healthcare industry, which already grapples with attracting and retaining staff.

2. Growing M&A Trend in Healthcare: With M&A activities in the healthcare sector on the rise, evidenced by a surge in hospital transactions in 2024, worth $12 billion, ongoing staffing challenges, wage hikes, and inflation are identified as primary drivers, exacerbating employee apprehension.

3. Importance of Transparent Communication and Benefits Clarity: Amid M&As, maintaining transparent communication from senior leadership and providing clear information on benefit changes are crucial. Employees prioritize access to resources explaining new benefits and require communication channels that accommodate their work schedules, especially pertinent for healthcare workers with demanding schedules. Additionally, assurances regarding job security and enhancements in pay and benefits are pivotal for staff retention amidst organizational changes.

ICHRA growth up nearly 30% since 2023

By Jacob Emerson - Employer adoption of ICHRAs is up 29% since 2023, according to a May 16 report from the HRA Council. ICHRAs, or individual coverage health reimbursement arrangements, allow employers to offer a defined tax-advantaged contribution used to reimburse premiums for an individual health plan purchased by an employee on their state's ACA exchange. Read Full Article…

HVBA Article Summary

1. Significant Growth in ICHRA Adoption: Between 2023 and 2024, the adoption of ICHRAs experienced a remarkable surge, with a 29% increase year over year, showcasing a growing trend towards this model of healthcare provision.

2. Explosive Growth Among Large Employers: Larger enterprises, those with 50 or more employees, saw an even more substantial rise in ICHRA implementation, boasting an 84% growth rate. This indicates a shifting preference among sizable employers towards individualized health coverage solutions.

3. Transformational Impact on Health Benefits Landscape: An overwhelming 83% of surveyed employers who previously couldn't provide health benefits were now able to do so through ICHRAs or Qualifying Small Employer HRAs. Additionally, 17% of employers made the switch from traditional group coverage, underscoring the disruptive influence of ICHRAs on the employer-sponsored health insurance paradigm.

Genetic profile may predict best response to weight-loss drug Wegovy

By Nancy Lipid - Certain genes may identify patients with obesity who are most likely to respond strongly to Novo Nordisk's (NOVOb.CO), weight-loss drug Wegovy, researchers reported on Monday. Read Full Article…

HVBA Article Summary

1. Genetic Profile Predicts Treatment Response: The study presented at the Digestive Disease Week meeting revealed a strong correlation between a specific genetic profile and the efficacy of Wegovy treatment. Patients possessing this genetic profile showed a 95% likelihood of being robust responders to the drug.

2. Personalized Medicine Potential: Dr. Andres Acosta of the Mayo Clinic highlighted the potential for utilizing these findings to tailor treatment decisions. Identifying patients with the genetic markers associated with a "hungry gut" could optimize the allocation of expensive treatments like Wegovy, ensuring those most likely to benefit receive the medication.

3. Cost-Effectiveness and Treatment Selection: The study's results underscore the economic considerations surrounding obesity treatment. While patients with the genetic profile experienced significant weight loss on Wegovy, those lacking the markers may achieve comparable results with more affordable alternatives. This prompts crucial questions about cost-effectiveness and the necessity of expensive interventions, urging exploration of cheaper yet equally efficacious options for certain individuals, such as other medications or surgical interventions.

Amid proposed health insurance rate hikes, Vermont businesses say health costs are slowing growth

By Elodie Reed - As Vermont health insurers are proposing hefty 2025 rate hikes for individual and small group plan premiums, members of the business community say that high health care costs are slowing down the local economy. Read Full Article…

HVBA Article Summary

1. Healthcare Costs Stifle Entrepreneurial Growth: According to Gwen Pokalo Hart of the Vermont Women’s Business Center, healthcare expenses represent a significant barrier for women entrepreneurs, hindering business growth. High healthcare costs, including uncovered prescription drugs, often lead to intensive medical debt and force some business owners to shut down their ventures.

2. Lack of Insurance Hampers Stability and Growth: Sam Roach-Gerber, Vice President of VCET, highlighted the challenges faced by individuals transitioning into part-time roles without employer-provided health insurance. This lack of stability poses a barrier to entrepreneurship and business scaling, particularly for those without alternative insurance options, such as spouses' coverage.

3. Legislative Solutions to Address Rising Drug Costs: Sen. Peter Welch advocated for legislative action to tackle rising prescription drug prices, emphasizing the need to reform the patent system to prevent anti-competitive practices by pharmaceutical companies. Proposed legislation aims to curb patent thickets, which drive up drug costs, and seeks to restore market competition principles to ensure affordable access to medications for businesses and consumers alike.

Why One New York Health System Stopped Suing Its Patients

By Noam N. Levey - Jolynn Mungenast spends her days looking for ways to help people pay their hospital bills. Working out of a warehouse-like building in a scruffy corner of this former industrial town, Mungenast gently walks patients through health insurance options, financial aid, and payment plans. Read Full Article…

HVBA Article Summary

1. Understanding Patient Constraints: Financial counselor Mungenast highlights that while most patients want to pay their medical bills, they often find themselves unable to do so due to fear, uncertainty, and financial constraints. This includes concerns about credit rating damage, potential loss of assets, and the impact on their livelihoods, indicating a broader issue beyond unwillingness to settle debts.

2. Innovative Solutions Over Aggressive Collections: Rochester Regional Health's approach diverges from the norm by forgoing aggressive collection tactics. Instead of resorting to lawsuits or wage garnishments, the health system focuses on understanding and addressing the root causes of patients' inability to pay. By offering assistance programs, simplifying the application process, and providing interest-free payment plans, they aim to alleviate the financial burden on patients while rebuilding trust within the community.

3. Promoting Health Equity and Trust: By refraining from aggressive collection practices and prioritizing patient well-being, Rochester Regional Health underscores a shift towards promoting health equity and fostering patient trust. This approach not only aligns with the core values of healthcare but also reflects a recognition of the socioeconomic challenges many individuals face in meeting their medical expenses. This model challenges the status quo, suggesting that effective healthcare delivery involves more than financial transactions—it necessitates empathy, understanding, and collaboration between providers and patients.

What Complexity Science Predicts About the Potential of Artificial Intelligence/Machine Learning to Improve Primary Care

By Richard A. Young, Carmel M. Martin, Joachim P. Sturmberg, Sally Hall, Andrew Bazemore, Ioannis A. Kakadiaris and Steven Lin - Primary care physicians are likely both excited and apprehensive at the prospects for artificial intelligence (AI) and machine learning (ML). Complexity science may provide insight into which AI/ML applications will most likely affect primary care in the future. Read Full Article…

HVBA Article Summary

1. Successful Implementation in Diagnosis: AI/ML has demonstrated success in diagnosing specific diseases from digital images, such as diabetic retinopathy from retinal scans and breast cancer from mammogram imaging. However, these successes often provide a preliminary guess rather than a definitive diagnosis, augmenting a physician's knowledge rather than replacing it entirely. Additionally, the effectiveness of AI/ML in diagnosis can be compromised by nonsensical correlations in data and challenges in accurately assessing diagnostic accuracy outside of well-structured case vignettes.

2. Limitations in Treatment Recommendations: While AI/ML shows promise in quickly synthesizing vast amounts of medical information for treatment decision-making, its effectiveness in recommending treatments for complex diseases like cancer is limited. Studies have shown that AI tools like IBM Watson did not improve upon oncologists' decisions, highlighting the challenges in integrating clinical findings and the complexity of primary care tasks. Moreover, AI/ML models based solely on historic data may not represent ideal prescribing practices in evolving medical environments, potentially compromising patient safety.

3. Complex Adaptive System Framework: AI/ML's effectiveness in primary care is influenced by various factors, including data quality, task scope, and integration into existing workflows. While AI/ML can excel in tasks with limited scope and clean, linear data, its performance diminishes in complex primary care settings characterized by data errors, nonlinear relationships, and diverse patient presentations. Successful AI/ML implementations, such as those in Victoria, Australia, emphasize the augmentation of existing relationships and human-driven processes rather than the replacement of complex decision-making by clinicians and their teams.

Prices Paid to Hospitals by Private Health Plans

By Christopher M. Whaley, Rose Kerber, Daniel Wang, Aaron Kofner, and Brian Briscombe - Because employer-sponsored spending comes from employee wages and benefits, employers have a fiduciary responsibility to administer benefits in the interest of participants. The lack of transparency of prices in the health care market limits employers' ability to knowledgeably develop or implement benefit design decisions. Read Full Article…

HVBA Article Summary

1. Regional Disparities in Hospital Pricing: Across the United States, significant discrepancies exist in hospital pricing relative to Medicare rates. Only Arkansas maintains prices below 170 percent of Medicare, while states like California, Florida, and New York exceed 300 percent.

2. Consistent Overpayment by Private Insurers: In 2022, private insurers consistently paid an average of 254 percent of Medicare rates for both inpatient and outpatient services across hospitals nationwide. This pattern has remained stable over several years, indicating a persistent trend of overpayment.

3. ASC vs. HOPD Pricing Dynamics: Prices for common outpatient services in Ambulatory Surgery Centers (ASCs) are notably lower compared to Hospital Outpatient Departments (HOPDs). While ASC prices average 171 percent of Medicare rates, they would approximate 107 percent if based on HOPD rates, suggesting a significant pricing difference influenced by service setting.

Setmelanotide Shows Promise in Hypothalamic Obesity

By Poonam Patil - Setmelanotide treatment over a 16-week period leads to a consistent decrease in both bodyweight and hunger among patients with hypothalamic obesity, according to the results of the first known study investigating the use of this targeted treatment in this indication. Read Full Article…

HVBA Article Summary

1. Study Design and Treatment Protocol: The phase 2, open-label study investigated the use of the melanocortin-4 receptor agonist setmelanotide as a targeted treatment for hypothalamic obesity. Patients were administered age-dependent setmelanotide dose titration for the first 4 weeks, followed by a fixed dose of 3.0 mg subcutaneous setmelanotide daily for 12 weeks, totaling a 16-week treatment duration.

2. Efficacy and Safety Outcomes: Out of 18 participants enrolled, 16 (89%) achieved a ≥ 5% reduction in BMI after 16 weeks of treatment, indicating significant efficacy (P < .0001). The reduction in BMI, body weight, and waist circumference among all patients was notable, with mean percent changes of -15%, -13%, and -10% respectively. Despite promising efficacy, adverse events were reported, with nausea, vomiting, skin hyperpigmentation, and diarrhea being the most common.

3. Implications and Considerations: The study's findings suggest that setmelanotide may offer a promising treatment option for hypothalamic obesity. However, limitations including the study's size, lack of control group, and potential patient heterogeneity should be noted. Additionally, the absence of dietary or exercise guidance and adjustments warrants consideration in interpreting the results. Further research with larger, controlled trials is necessary to validate these findings and elucidate the long-term safety and efficacy of setmelanotide in treating hypothalamic obesity.