Daily Industry Report - May 7

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)
Editor-In-Chief
Daily Industry Report (DIR)

Robert S. Shestack, CCSS, CVBS, CFF
Chairman & CEO
Health & Voluntary Benefits Association® (HVBA)
Publisher
Daily Industry Report (DIR)

Biden administration: DACA recipients eligible for ACA coverage

By Rylee Wilson - Individuals who are part of the Deferred Action for Childhood Arrivals program will be able to enroll in ACA marketplace plans beginning in November. Read Full Article…

VBA Article Summary

  1. Marketplace Eligibility Expansion: CMS announced on May 3 a final rule extending marketplace eligibility to DACA recipients. This move signifies a significant step towards providing healthcare coverage to individuals brought to the U.S. as children without legal status.

  2. Projected Coverage Impact: With an estimated 100,000 uninsured DACA recipients expected to receive coverage through the program, this extension holds the potential to address a substantial portion of the uninsured population among DACA beneficiaries.

  3. Medicaid Eligibility Expansion Not Finalized: Despite the marketplace eligibility expansion, CMS did not finalize a rule to extend Medicaid eligibility to DACA recipients, a change that would have provided insurance coverage to approximately 500,000 individuals. This underscores the ongoing complexities in healthcare access for this demographic.

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Should New Entrants Bother With Selling Point Solutions To Employers?

By Marissa Plescia - In the employer space, point solution fatigue seems to be growing steadily over the years. Employers are balancing multiple point solutions from different vendors that target specific conditions and populations, and managing all of these solutions at once can be a challenge. Read Full Article…

VBA Article Summary

  1. Challenges in Targeting Employers: Christina Farr and Peter Hames argue that startups should be cautious in targeting employers due to high competition and the specific nature of solutions that may not address broad enough needs. The digital health market has become saturated with vendors, leading to decision fatigue among employers, and often, the solutions do not engage employees effectively or prove their efficacy clearly.

  2. Exceptions and Opportunities: Despite general advice to steer clear, there are exceptions for startups that tackle significant cost issues or provide essential navigation services. These areas still present opportunities as they address major needs within employer health plans, such as managing high-cost conditions like cancer or integrating complex benefits into more accessible platforms.

  3. Views on the Future of Employer Engagement: The article includes varying perspectives on the future of this market. While some advocate for a reduced focus on the employer market, others see potential for startups to innovate and provide value. This involves proving quick, measurable benefits to employers, focusing on high-impact areas, and possibly moving towards value-based arrangements where vendors share financial risks and rewards with employers.

VBA Poll Question of the Week - Please share your insights

In your opinion, which factor weighs most heavily when choosing an insurance payment structure?

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Our last poll results are in!

27.78%

of Daily Industry Report readers who responded to our last polling question with “Retainer/PEPM” when asked “When it comes to receiving compensation on insurance programs, which payment structure do you prefer?"

24.88% of respondents said “Heaped,” 24.20% Hybrid,” while 23.13% prefer “Levelized.”

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

Biden Administration: 100,000 Migrants Expected to Enroll in Obamacare Next Year

By Associated Press - Roughly 100,000 immigrants who were brought to the U.S. as children are expected to enroll in the Affordable Care Act (ACA) next year under a new directive the Biden administration released Friday. Read Full Article…

VBA Article Summary

  1. Delayed Implementation and Shortfalls: Despite President Biden's initial proposal falling short, the action allows thousands of migrants, particularly DACA participants, to access lucrative tax breaks through the ACA marketplace. However, the process took longer than promised to finalize, raising questions about the administration's efficiency and its ability to fulfill campaign promises.

  2. Impact on Voter Appeal and Criticism: While the move may enhance Biden's appeal among Latino voters, a crucial demographic for his electoral success, it's likely to invite criticism from conservatives regarding the administration's border and migrant policies. The timing of the action, just days ahead of the presidential election, underscores its political significance and potential implications for voter sentiment.

  3. Healthcare Access and Economic Implications: By expanding eligibility for DACA participants to enroll in the marketplace exchange, the administration aims to address the healthcare needs of this group, improving their health outcomes and reducing financial burdens associated with delayed care. Additionally, the move is expected to have broader implications for the nation's economy and public health by strengthening the well-being of both migrants and the overall population.

Most Americans say mental health issues get worse treatment than physical ones

By Maya Goldman - Three in four adults think the U.S. health care system identifies and treats mental health issues worse than physical health concerns, according to a new Gallup and West Health poll. Read Full Article…

VBA Article Summary

  1. Perception and Access to Care: Negative perceptions surrounding mental health can act as significant barriers to seeking treatment, potentially leading to undiagnosed or unaddressed conditions. According to Timothy Lash, president of West Health, shifting perceptions of barriers to care, particularly as individuals age, can deter people from seeking treatment even when it's available.

  2. Seniors and Mental Health Access: Seniors face heightened challenges in accessing mental health care, with 82% struggling to obtain the necessary treatment. This demographic, often in greater need of support, encounters additional hurdles in seeking mental health services.

  3. Social Stigma and Barriers: A substantial portion of the population (70%) perceives society as holding negative views toward individuals with mental health conditions. Affordability (52%) and the difficulty in finding mental health providers (42%) emerge as primary barriers, indicating a multifaceted challenge beyond mere availability.

Amgen Puts Its Weight Behind Obesity Drug With Potential Edge Over Lilly, Novo Nordisk Meds

By Frank Vinluan - Amgen aims to challenge the Novo Nordisk and Eli Lilly duopoly in the market for injectable obesity medications, and the company is now preparing for Phase 3 testing of an injectable drug candidate that would introduce new competition. Read Full Article…

VBA Article Summary

  1. Confidence in MariTide's Potential: Despite withholding specific clinical data, Amgen's CEO expressed confidence in MariTide's differentiated profile during a recent conference call. The drug candidate, leveraging Amgen’s expertise in antibody drugs, offers a dual mechanism of action, activating the GLP-1 receptor while blocking the GIP receptor. This unique design holds promise in addressing unmet medical needs, particularly in conditions like obesity and type 2 diabetes.

  2. Advantages in Dosing and Manufacturing: Amgen’s MariTide presents potential dosing and manufacturing advantages compared to existing peptide-based medications for weight management. While specific details are not yet disclosed, preliminary data suggest MariTide may allow for less frequent dosing, potentially on a monthly basis, via an autoinjector device. This dosing schedule not only offers convenience for patients but also reduces the manufacturing burden associated with producing the drug and its delivery devices.

  3. Anticipated Impact on Treatment Landscape: Analysts anticipate MariTide could disrupt the current treatment landscape for metabolic disorders, offering a compelling alternative to existing medications such as Wegovy and Zepbound. Despite expectations of similar side effects, the prospect of less frequent dosing with MariTide is viewed favorably, potentially reducing total sick days for patients. Additionally, Amgen's strategic decision to focus on MariTide and other promising assets underscores the company's commitment to advancing innovative solutions in the field of metabolic diseases.

Ransomware attacks on healthcare impact nearly five times more sensitive data: report

By Emily Olsen - Cyberattacks are a serious threat to healthcare operations, and they’ve become increasingly common over the past five years. Read Full Article…

VBA Article Summary

  1. Increased Vulnerability in Healthcare: According to a report by Rubrik Zero Labs, healthcare organizations are particularly susceptible to ransomware attacks, with 20% of their sensitive data holdings impacted in such events—significantly higher than the 6% average for other industries. This makes the healthcare sector a prime target due to their substantial volume of sensitive data, which averages 42 million records, compared to a global average of 28 million.

  2. Consequences of Ransomware Attacks: Ransomware attacks in the healthcare sector can lead to severe disruptions, as evidenced by the February cyberattack on UnitedHealth-owned Change Healthcare. This incident compromised essential operations like billing and patient data management, illustrating the potentially devastating impacts on hospital functionality and patient care continuity.

  3. Legislative and Policy Responses: The growing threat of cybersecurity breaches in healthcare has drawn attention from regulators and lawmakers. Initiatives such as the voluntary cybersecurity goals released by the HHS and the inclusion of funds in the Biden administration’s 2025 budget proposal aim to enhance hospital protections. However, there is concern that these measures may not be sufficient, especially for small and rural healthcare providers, which remain highly vulnerable.

Telemedicine, enabled with responsible AI, can improve the patient experience

By Bill Siwicki - In the ever-evolving landscape of healthcare, the integration of virtual care has become pivotal in reshaping patient experiences. Read Full Article…

VBA Article Summary

  1. Expanding the Digital Front Door: Telemedicine has the potential to extend beyond mere patient acquisition, becoming a pivotal tool in creating a holistic care experience. By integrating telemedicine throughout the patient journey, healthcare organizations can offer seamless access to care, particularly benefiting chronic disease management programs. Patients can now connect with their care teams from home, fostering better communication and timely interventions, ultimately enhancing the overall patient experience.

  2. Enhancing Engagement through Accessibility: Telehealth addresses the three essential "E's" of healthcare—education, experience, and empowerment. By eliminating barriers like time off work or transportation challenges, telehealth ensures patients can engage with their providers more regularly and consistently. Moreover, it serves as a platform for patient education, offering not only immediate care but also valuable resources and services. This approach fosters a stronger patient-provider relationship, empowering patients to take an active role in their health journey.

  3. Responsible AI for Personalized Care: Responsible AI innovation in telemedicine enhances patient engagement by providing tailored guidance and recommendations based on individual needs and circumstances. Through AI-powered tools integrated into familiar platforms, patients receive personalized care options, including telemedicine, optimized for their health profile. Crucially, responsible AI ensures algorithms are unbiased, clinically validated, and transparent, fostering trust and confidence in the technology while delivering a more personalized and effective telemedicine experience.

UnitedHealth CEO estimates one-third of Americans could be impacted by Change Healthcare cyberattack

By Ashley Capoot - UnitedHealth Group CEO Andrew Witty on Wednesday told lawmakers that data from an estimated one-third of Americans could have been compromised in the cyberattack on its subsidiary Change Healthcare, and that the company paid a $22 million ransom to hackers. Read Full Article…

VBA Article Summary

  1. Scope of Breach and Ongoing Investigation: Witty testified before the Subcommittee on Oversight and Investigations, revealing that the investigation into the breach impacting UnitedHealth is ongoing, making it challenging to ascertain the exact number of affected individuals. The rough estimate suggests that around one-third of individuals might be affected, highlighting the scale of the potential impact.

  2. Cybersecurity Response and Fallout: UnitedHealth's disclosure emphasized the severity of the cyberattack, confirming the compromise of files containing protected health information and personally identifiable information. The complexity of the data review suggests that it could take months before affected individuals are notified. To address concerns, the company is offering identity theft protection and credit monitoring.

  3. Ransom Payment and Security Measures: Witty's testimony revealed significant details about the breach, including the revelation that UnitedHealth paid a $22 million ransom in bitcoin to the hackers who breached Change Healthcare, a subsidiary. The breach occurred due to compromised credentials, with the ransomware encryption deployed nine days later. To bolster security, UnitedHealth has implemented multifactor authentication across all external-facing systems in response to the breach.

Study: Combine intermittent fasting with high-intensity exercise to boost health

By Susan Kreimer - Among inactive women with obesity, combining time-restricted eating with high-intensity exercise may lead to more transformative changes in body composition and cardiometabolic health than either intervention alone, a new study suggests. Read Full Article…

VBA Article Summary

  1. Components of Cardiometabolic Health: Cardiometabolic health encompasses fat mass, insulin sensitivity, glucose, lipid profile, and blood pressure, crucial factors in assessing overall health and risk of cardiovascular diseases.

  2. Effectiveness of Lifestyle Modifications: While diet and exercise are established methods for improving cardiometabolic health, finding a sustainable combination can be challenging. Time-restricted eating and high-intensity functional training offer promising avenues, as they focus on when and how individuals eat and exercise rather than solely on calorie restriction.

  3. Synergistic Benefits of Combined Approach: Combining time-restricted eating with high-intensity functional training yields significant improvements in body composition and cardiometabolic parameters. This synergistic effect enhances muscle mass retention, fat loss, and overall health, potentially reducing the risk of chronic diseases like heart disease and type 2 diabetes.

What if I can't find a doctor? Physician shortage will change how Americans receive care.

By Dr. Vin Gupta - The most urgent threat to our health isn't a microscopic virus or strain of bacteria. It's a shortage of doctors. A whopping 83 million Americans don't have sufficient access to a primary care provider. Within a decade, we could be short almost 50,000 primary care physicians. Read Full Article…

VBA Article Summary

  1. Maximizing Existing Resources: With the shortage of doctors expected to persist for years, if not decades, it's imperative to optimize the current healthcare workforce. This involves making the system more efficient and embracing proactive illness management strategies. The aim is to alleviate the burden on providers and reduce patient wait times, which can have significant implications for both health outcomes and the economy.

  2. Harnessing Digital Health Solutions: Embracing the digital revolution in healthcare delivery, from telehealth services to home delivery pharmacies, offers a viable solution to enhance efficiency and accessibility. Telemedicine, for instance, not only optimizes doctors' schedules but also addresses patient concerns regarding travel and wait times. Integrating virtual care with remote patient-monitoring tools further enhances patient-provider communication and can significantly reduce hospital readmissions.

  3. Improving Medication Adherence: Nonadherence to prescribed medications presents a significant challenge in managing chronic conditions, leading to avoidable healthcare costs and adverse health outcomes. Leveraging online pharmacy alternatives and delivery services can improve medication adherence rates by providing convenience, clarity on pricing, and personalized care. By addressing barriers to medication adherence, such initiatives can contribute to better health outcomes and overall system efficiency.