Employees favor human support over AI for open enrollment, claim resolution

By Lucy Peterson – As open enrollment season is underway for employees across the U.S., a new study released by New York Life Group Benefits Solutions found that despite the growing availability of AI solutions, employees still prefer human-centric guidance to close the benefits knowledge gap. The study found that 62% of respondents have an especially strong preference for human support when discussing sensitive life events such as bereavement, caregiving, childcare, mental health and pregnancy. Additionally, 54% of respondents expressed a notable preference for human support when working to resolve a billing or claim matter. Read Full Article...

HVBA Article Summary

1. Strong Preference for Human Support in Benefits Navigation: Survey results show that a significant majority of employees prefer human-only support when navigating benefits—70% for understanding time-off policies and 68% for enrolling in benefits. Only 39% and 37%, respectively, were open to a combination of AI, digital, and human support. Fewer than 10% preferred AI-only assistance. This indicates that, despite the availability of digital tools, most employees still place a higher value on direct human interaction when making decisions that affect their well-being.

2. Technology Has a Role, But Empathy Is Crucial: While AI and digital platforms help streamline processes and broaden access, they are not seen as adequate replacements for human empathy. As emphasized by leadership at New York Life Group Benefit Solutions, employees facing personal or sensitive circumstances seek emotional support, which only human interactions can provide. This highlights the importance of balancing digital efficiency with genuine, compassionate human support.

3. Persistent Knowledge Gaps in Benefits Understanding: The survey reveals ongoing challenges in employee understanding of their benefits. Only 43% feel they know how to enroll in their benefits, and just 36% feel highly knowledgeable about which benefits meet their personal needs. Despite improvements in digital tools and communication, these figures have not seen major improvement year-over-year, pointing to the continued need for employers to invest in personalized, year-round education and support—not just during the open enrollment period.

Why Healthcare Leaders Are Worried About the New H-1B Visa Fee 

By Katie Adams – The Trump administration’s recent changes to the H-1B visa application process are causing concern among healthcare experts, with many worried that the plan could make the industry’s workforce crisis and care access gaps more severe. Last month, the White House imposed a $100,000 fee on new H-1B visa petitions. Before, the fee typically ranged between $2,000 and $5,000, depending on the employer. This new fee applies only to new H-1B visa applicants, not current H1-B holders whose employers are seeking to renew their visas. Read Full Article...

HVBA Article Summary

1. Policy Shift Aims to Curb Abuse but Raises Legal and Procedural Concerns: The White House plans to impose a $100,000 fee per new H-1B hire and prioritize applicants with higher wages through a weighted lottery system. This is intended to discourage the use of H-1B visas for lower-paid, lower-skilled labor, which the White House claims has replaced rather than supplemented U.S. workers. However, the plan has already sparked legal pushback. For example, healthcare employers, unions, religious groups (Oct 3), and higher education organizations (Oct 6) have filed lawsuits, arguing the changes may violate the Administrative Procedure Act and overstep executive authority by bypassing congressional approval.

2. Healthcare Sector Warns of Worsening Shortages and Burnout: Despite the relatively low use of H-1B visas in healthcare (only 8,492 of 141,205 new H-1B approvals and 8,445 of 258,190 renewals in FY 2024 were for healthcare roles), providers still depend on them for critical staffing needs. The American Hospital Association and healthcare attorneys warn that the new $100,000 fee could financially cripple community hospitals and clinics, particularly in rural and underserved areas. The U.S. is projected to face a shortfall of 187,130 physicians by 2037, with nurse shortages expected to hit 13% in non-metro areas. Without exemptions, providers may face seven- to eight-figure annual liabilities, leading to hiring freezes, longer shifts, or facility closures.

3. Restrictions May Hamper Innovation in Health Tech and Research: About 65% of all H-1B visa holders work in the tech sector, which significantly overlaps with healthcare innovation industries like digital health, pharmaceuticals, and medical devices. Experts warn that higher barriers to entry for foreign talent — many of whom are Indian nationals — could slow development in areas such as AI tools and new drug/device creation. Sujay Saha, president of Cortico-X and a former H-1B holder, cautions that rising costs may lead U.S. companies to establish R&D operations abroad, potentially diminishing the country’s leadership in healthcare innovation.

AMA's handling of CPT codes enters Congress' crosshairs

By Dave Muoio – The top senator on healthcare policy is taking a hard look at the American Medical Association’s “anti-patient and anti-doctor” handling of the healthcare system’s near-ubiquitous billing and claims processing codes. Bill Cassidy, M.D., R-Louisiana, who chairs the Senate Health, Education, Labor and Pensions (HELP) Committee, chastised the nation’s leading physician association for “abusing” the Current Procedural Terminology (CPT) coding system and said he will be “actively reviewing” the issue. Read Full Article...

HVBA Article Summary

1. Senator Bill Cassidy's Review of AMA's CPT Code Practices: Senator Cassidy, chair of the Senate HELP Committee, has initiated a review of the American Medical Association's management of the CPT code system, criticizing it for charging high fees to users such as doctors, hospitals, and health plans. He argues these fees contribute to increased healthcare costs for patients. The review includes requests for detailed financial information and the AMA's process for incorporating provider feedback into code finalization.

2. Concerns Over AMA's Broader Advocacy and Spending: Cassidy's letter also highlights political concerns, accusing the AMA of engaging in "anti-patient, anti-science advocacy efforts" related to gender-affirming care and diversity, equity, and inclusion initiatives. He requested information on the AMA's expenditures in these areas for 2024, linking these issues to the broader scrutiny of the organization's practices and policies.

3. AMA's Role and CPT Code System Overview: The AMA has maintained a government-backed monopoly over the CPT code set, which includes over 11,000 codes used nationwide for billing and claims processing. The CPT Editorial Panel, composed of 21 members and representatives from various medical societies, reviews and updates codes regularly. The AMA released its 2026 CPT code set recently, which includes significant changes addressing new technologies such as AI services and remote monitoring.

Colorado becomes first state to cap price of prescription drug

By Alan Goforth – Colorado has become the first state to place a price cap on a prescription drug. After years of deliberation, the state’s Prescription Drug Affordability Review Board has enacted a cap on the price of Enbrel from Immunex Corp., which is used to treat rheumatoid arthritis and other autoimmune diseases. “This groundbreaking upper payment limit on Enbrel has the potential to save $32 million from drug spending,” said Sophia Hennessy, lead policy research coordinator for the Colorado Consumer Health Initiative, according to The Colorado Sun. “We’re thrilled with the board’s decision today that helps ensure more patients can afford their vital medications.” Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Price Cap Details and Impact: Colorado’s Prescription Drug Affordability Review Board capped the annual price of Enbrel, a drug used to treat rheumatoid arthritis and autoimmune diseases, at about $31,000, down from approximately $58,000 in 2023. This cap reduces the patient’s annual cost from around $4,000 to $600, potentially saving $32 million in drug spending. About 60% of the 2,500 Coloradans taking Enbrel are privately insured, making this price cap significant for a large portion of users in the state.

2. Concerns and Opposition: Despite the potential savings, several groups including patient advocacy organizations, hospitals, pharmacies, and providers have expressed concerns about unintended consequences. They warn that the price cap could lead manufacturers to withdraw from the Colorado market or insurers to stop covering the drug. The insurance industry also cautioned that insurers might alter drug formularies or use utilization management tools, which could affect patient access.

3. Regulatory Process and Optimism: The review board was established by legislators in 2021 and follows a comprehensive process involving data analysis, surveys, public comments, and hearings before setting price limits. While some stakeholders remain cautious, board member Cathy Harshbarger expressed optimism about the impact of the price cap on Colorado residents. The board’s decision marks a pioneering step in state-level drug price regulation, potentially influencing other states’ approaches to drug affordability.

Dems open to income cap on ACA subsidies

By Peter Sullivan – Some moderate Senate Democrats say they are open to placing an income cap on eligibility for Affordable Care Act tax credits to help facilitate a deal with Republicans. Why it matters: The way high earners can tap ACA tax credits is helping drive Republican resistance to renewing the subsidies. An income cap is almost essential to a potential deal, whether as part of negotiations to reopen the government or as part of a health care package later this year. Read Full Article...

HVBA Article Summary

1. Democratic Support for Income Limits on ACA Subsidies: Several Democratic senators, including Jeanne Shaheen (D-N.H.) and Tim Kaine (D-Va.), indicated they are open to implementing income-based eligibility limits for ACA tax credits. They support the idea of means testing federal benefits at higher income levels, though the exact thresholds would need to be negotiated. However, Democrats also stress that meaningful talks can't happen without Republican cooperation.

2. Republican Preconditions and Broader Demands: Republicans are demanding that Democrats agree to reopen the government before any substantive negotiations on ACA subsidies begin. Beyond income limits, they are advocating for structural changes, such as requiring minimum premium contributions to reduce $0 premium plans—citing concerns about potential fraud—and insisting on language that would block the use of subsidies for abortion services. Some in the GOP remain opposed to extending the subsidies at all.

3. Stalemate Threatens Subsidy Extension for Millions: Approximately 22 million Americans currently benefit from enhanced ACA subsidies, which are set to expire at the end of the year unless Congress intervenes. These subsidies were expanded during the pandemic by lifting the previous income cap of 400% of the federal poverty level. While there is limited bipartisan openness to extending support, the current political gridlock—fueled by disagreements over conditions and the ongoing government shutdown—puts the future of these subsidies in jeopardy.

Employers pay more than $1,000 for some 'free' preventive services

By Allison Bell – Some of the preventive services that are "free" for U.S. patients with employer health plan coverage cost the employers and their insurers plenty. Seven of the 130 services included in the current Affordable Care Act preventive services package typically cost an employer's self-insured health plan or a group health insurance provider more than $1,000 per patient, according to a Health Care Cost Institute analysis of 2022 employer plan claim data. The two most expensive items in the package are related to HIV. In 2022, providing an injection that protects a patient against being infected by HIV cost an average of $3,898, and the antiviral drugs used to keep HIV infections from causing full-blown AIDS cost $1,926, HCCI reported. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. High Costs for Certain 'Free' Preventive Services: Although preventive services are labeled as 'free' for patients under employer health plans due to the Affordable Care Act, some services cost employers and insurers over $1,000 per patient. Notably, HIV-related preventive treatments such as protective injections and antiviral drugs are among the most expensive, with costs reaching nearly $3,900 and $1,926 respectively in 2022. This highlights the significant financial burden on employer-sponsored health plans despite the absence of direct patient charges.

2. Varied Costs Across Preventive Services: The analysis by the Health Care Cost Institute shows a wide range of costs among preventive services. While some procedures like automated red blood cell counts cost as little as $3, others related to colon cancer screening and contraceptive systems like the Mirena IUD exceed $1,200. This disparity underscores the complexity of healthcare pricing and the challenges employers face in managing plan costs effectively.

3. Preventive Services and Long-Term Health Impact: The Affordable Care Act mandates coverage of preventive services without cost-sharing to improve health outcomes and potentially reduce overall healthcare expenses over time. However, measuring the short-term impact of these services can be difficult, as many benefits manifest later in life. Employers and payers continue to seek ways to evaluate the effectiveness of preventive care in improving quality and controlling costs in the long run.

Over-the-Counter CGMs Are Here — But Do They Really Make Sense for Non-Diabetics?

By Katie Adams – Continuous glucose monitors are no longer just for people with diabetes. In March of last year, DexCom gained FDA clearance for its over-the-counter CGM, and then a couple of months later, its main competitor Abbott earned clearance for two over-the-counter CGM devices of its own. The FDA cleared these over-the-counter CGMs for use in people with and without diabetes, but questions still remain about how clinicians and individuals can interpret the data that these devices collect. To explore what CGM data really means outside of diabetes care, researchers at Mass General Brigham in Boston conducted a study. Read Full Article...

HVBA Article Summary

1. CGM Accuracy Depends on Diabetes Status: The study analyzed 972 participants aged 40 and older, of whom 421 had type 2 diabetes, 319 had prediabetes, and 232 had normal blood sugar. CGM-derived metrics (e.g. average glucose, time in range) closely matched standard clinical measures in the group with diabetes, whereas among those with prediabetes or normal glucose, the alignment was weaker — indicating that CGM readings are more reliable in populations with overt glucose dysregulation.

2. Most Useful for Short-Term Lifestyle Insights: The researchers suggest CGMs may not yet replace diagnostic tools, especially in non-diabetic populations, but are valuable for capturing how diet, activity, or sleep influence glucose on a finer timescale. Anecdotal evidence from one of the authors illustrated that even in someone without diagnosed glucose problems, a meal (soup with hidden rice noodles) caused prolonged glucose elevation — a trend only visible through CGM.

3. Need for Further Research in Non‑Diabetic Use: The current study was limited by its cross-sectional design, which captures data at only a single point in time. Researchers emphasized the importance of conducting longer-term, longitudinal studies to determine whether glucose patterns in people without diabetes — as measured by CGMs — have any predictive value for chronic conditions like type 2 diabetes, heart disease, or stroke.

ChatGPT Advice Triggers Bromide Poisoning, Psychosis

By Benjamin Burgard – A 60-year-old man developed paranoia and hallucinations after using sodium bromide as a table salt substitute for 3 months on the advice of an artificial intelligence (AI) tool. Laboratory tests showed high chloride with a negative anion gap and metabolic alkalosis from halide interference. Further testing confirmed markedly elevated bromide levels. A case report by Audrey Eichenberger, MD, University of Washington, Seattle, describes bromism after the patient consulted ChatGPT for health information. Read Full Article...

HVBA Article Summary

1. AI Health Advice Can Lead to Harmful Outcomes: This case demonstrates that following health advice from AI tools like ChatGPT without clinical context or professional guidance can result in serious health issues, such as bromide poisoning and psychosis. The patient replaced sodium chloride with sodium bromide based on AI suggestions, which led to toxic levels of bromide and severe psychiatric symptoms. This highlights the risks of decontextualized AI recommendations in medical decision-making.

2. Clinical Presentation and Diagnosis of Bromism: The patient exhibited paranoia, hallucinations, and electrolyte abnormalities including hyperchloremia with a negative anion gap and metabolic alkalosis. His bromide levels were significantly elevated, confirming bromide toxicity. The diagnosis was complicated by the unusual laboratory findings and required consultation with poison control and psychiatric intervention.

3. Importance of Professional Medical Consultation: The authors emphasize that AI-generated advice should not replace direct consultation with healthcare professionals. Unlike clinicians, AI tools may not provide necessary safety warnings or consider individual clinical context. This case underscores the need for safety-critical context checking and clinician involvement when using consumer-facing AI for health information.