Another year, higher healthcare prices: Are employers ready for 2025?

By Deanna Cuadra - It shouldn't come as a shock that healthcare costs are expected to increase in 2025 — but that doesn't mean employers aren't prepared to mitigate the damage. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. The Rising Cost Burden on Employees: Employees are expected to bear an additional 5.8% in healthcare benefit costs in 2025, marking the third consecutive year of significant increases. This trend, as highlighted by Mercer, reflects a broader shift where rising costs are pushed onto workers, often deterring them from seeking necessary care and exacerbating long-term health issues.

2. The Role of Preventative Care in Cost Mitigation: Advanced primary care, which includes regular check-ups, screenings, and behavioral health management, can reduce overall healthcare expenses by addressing chronic conditions early. Employers are encouraged to eliminate financial barriers to accessing primary care, incentivize virtual visits, and strengthen employee trust in their primary care providers, as demonstrated by Centivo's success in increasing primary care visits and reducing ER visits.

3. A Call for Employers to Rethink Health Plan Strategies: Employers must critically evaluate their health plans to ensure they promote preventative care and chronic condition management rather than inadvertently worsening employee health outcomes. Subramanian advocates for greater employer control over health plan designs, emphasizing investments in primary care to align with successful models in non-privatized healthcare systems worldwide.

10 things to watch for with ACA open enrollment underway

By Alan Goforth - Navigating the annual Affordable Care Act Marketplace open enrollment season can be a bit like driving down a road that seems familiar but winds up having unexpected twists and turns. KFF has provided a roadmap to 10 things that brokers should watch for this year. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Modest Premium Increases and Enhanced Subsidies: While unsubsidized premiums are rising slightly—benchmark silver plans by 4% and lowest-cost bronze premiums by 5%—most Marketplace enrollees won't feel the impact. With enhanced subsidies, 92% of shoppers can find plans for less than $10 per month. However, these enhanced subsidies are set to expire at the end of 2025, potentially doubling net premiums in many states starting in 2026.

2. Expanded Choices and Marketplace Transitions: ACA Marketplace shoppers now have access to an average of 9.6 insurers per state, the highest ever. Additionally, Georgia will transition to a state-based Marketplace for 2025, increasing the total to 20 states.

3. Regulatory Changes and Special Enrollment Opportunities: New federal rules limit short-term health plans to four months and mandate clear disclosures about coverage limitations. Special enrollment remains open year-round for low-income enrollees on HealthCare.gov, and DACA recipients will gain access to subsidized coverage starting in 2025. Network adequacy rules, including appointment wait-time standards, will also be enforced beginning in 2025.

A.I. Chatbots Defeated Doctors at Diagnosing Illness

By Gina Kolata - Dr. Adam Rodman, an expert in internal medicine at Beth Israel Deaconess Medical Center in Boston, confidently expected that chatbots built to use artificial intelligence would help doctors diagnose illnesses. Read Full Article… 

HVBA Article Summary

1. ChatGPT's Superior Diagnostic Performance: In the study, ChatGPT-4 outperformed both doctors with and without its assistance, achieving an average diagnostic accuracy of 90% compared to the doctors' 76% and 74%, respectively. This highlights the potential of AI to surpass human performance in complex diagnostic tasks when evaluated purely on accuracy and reasoning.

2. Doctors’ Overconfidence and Underutilization of AI: Despite having access to ChatGPT, many doctors ignored its suggestions, particularly when they contradicted their own diagnoses. Additionally, most participants treated the chatbot like a basic search engine rather than leveraging its ability to analyze comprehensive case histories, limiting its effectiveness as a diagnostic tool.

3. Historical and Modern Challenges in AI-Driven Diagnosis: The study reflects decades of efforts to integrate AI into medical diagnostics, transitioning from complex systems like INTERNIST-1 to modern large language models. While ChatGPT demonstrated remarkable capabilities, challenges remain in fostering trust, reducing overconfidence among doctors, and teaching effective AI utilization to fully realize its potential as a "doctor extender."

An Integrated Approach to Optimizing Specialty Pharmacy and Accelerating Performance

By Matt Manning - Specialty medications are estimated to comprise 65% of drug spending by 2025, and health systems are rapidly addressing new industry demands with in-house programs to support high-cost, high-touch drug dispensing. Read Full Article… 

HVBA Article Summary

1. Addressing Operational Inefficiencies: Health systems must streamline workflows and eliminate bottlenecks by integrating specialty pharmacy operations with EHR systems and adopting specialty pharmacy management software. Automation of routine tasks, such as patient communications and compliance tracking, enhances efficiency, allowing pharmacy staff to focus on high-value activities like financial assistance and prior authorization verification.

2. Implementing Patient-Centered Strategies: Specialty pharmacies should prioritize personalized care by creating tailored medication management plans and offering robust patient education programs. Strengthening collaboration between pharmacy teams, physicians, and care coordinators ensures seamless care transitions, while holistic patient outreach programs address adherence challenges and improve overall patient satisfaction.

3. Harnessing Advanced Data Analytics: Leveraging real-time analytics platforms enables specialty pharmacies to identify performance gaps, optimize provider adoption, and improve drug access. Data-driven insights allow health systems to negotiate better payer contracts, enhance reimbursement accuracy, and identify opportunities for network expansion, ensuring sustainable growth and improved clinical outcomes.

GLP-1, SGLT2s lower mortality risk by 74% in stroke survivors: Study

By Elizabeth Gregerson - Stroke survivors who took GLP-1 or SGLT2 medications had a 74% lower risk of death, according to a preliminary study being presented at the American Heart Association's annual Scientific Sessions, set for Nov. 16-18. Read Full Article…

HVBA Article Summary

1. Significant Reduction in Mortality and Heart Attack Risk: Stroke survivors who took either GLP-1 or SGLT2 medications experienced a 74% reduction in the risk of death and an 84% reduction in the risk of heart attack compared to those who did not use these medications.

2. Lower Risk of Subsequent Stroke: Among those taking SGLT2 inhibitors specifically, there was a 67% decrease in the likelihood of a second stroke, highlighting their potential benefit in post-stroke management.

3. Comparative Mortality and Heart Attack Rates: The mortality rate was substantially lower at 11.8% for patients on these medications compared to 54% for those not on them. Similarly, heart attack rates dropped to 1.5% among treated survivors, compared to 6.1% in untreated ones, showcasing the clinical advantages of these therapies.

The value of virtual care: 5 things to know

By Giles Bruce - Telehealth doesn't increase the prevalence of low-value care, a new study found. Here are five things to know from the research published…in JAMA Network Open. Read Full Article…

HVBA Article Summary

1. Study Overview and Scope: Researchers from the University of Michigan analyzed data from 577,928 fee-for-service Medicare beneficiaries across 252 Michigan primary care practices (2019–2022), focusing on the use of eight medically unnecessary screenings. These included tests such as prostate cancer blood tests for men over 75, CT scans for back pain, and colon cancer screenings for individuals over 85.

2. Key Findings: Contrary to concerns that telehealth might drive overuse of low-value care, the study found no link between high telehealth usage and unnecessary testing. In fact, some tests, like cervical cancer screenings for women over 65 and thyroid hormone blood monitoring for hypothyroidism patients, were less frequent in clinics with high rates of virtual care.

3. Policy Implications: The findings provide reassurance for telehealth policies, alleviating fears that virtual care might increase unnecessary diagnostic practices. Lead author Dr. Terrence Liu emphasized that telehealth is not contributing to wasteful care, a critical consideration for healthcare system efficiency.

Do Patients on Anti-Obesity Drugs Decrease Alcohol Use?

By Miriam E. Tucker - Several types of anti-obesity medications (AOMs), including glucagon-like peptide 1s (GLP-1s), are associated with decreased alcohol use, new research suggests. Read Full Article… 

HVBA Article Summary

1. Significant Reductions in Alcohol Consumption Among AOM Users: The study, involving over 14,000 participants in WeightWatchers’ telehealth weight management program, found that 45% of individuals who consumed alcohol at baseline reported decreased drinking after starting anti-obesity medications (AOMs). The reduction was more pronounced among those with higher initial alcohol consumption, with up to 91% in the highest drinking category reporting decreased use. This pattern was consistent across various AOM classes, including GLP-1 drugs and bupropion/naltrexone.

2. Potential Mechanisms for Alcohol Reduction: Researchers identified both biological and behavioral factors influencing reduced alcohol consumption. Physiologically, participants on GLP-1 medications reported decreased cravings and negative reinforcement from drinking, such as severe hangovers. Behaviorally, many participants consciously reduced alcohol intake as part of their health-focused journeys, aiming to improve overall well-being and reduce calorie intake from alcohol.

3. Implications for Clinical Practice and Future Research: The findings suggest a potential role for AOMs in reducing alcohol use, especially in individuals with higher baseline alcohol consumption. Clinicians treating obesity may consider these medications for patients with elevated alcohol intake. Future research is needed to compare the effectiveness of AOMs with non-pharmacological interventions in reducing alcohol use and to better understand the biological pathways involved.