SIIA Government Relations Update

By SIIA - Election Day’s A’Coming – We are 18 days from Election Day. It remains unclear which political party will win the White House. And, no one really has a firm grasp on which political party will hold the majority in the House and Senate. Read Full Article… 

HVBA Article Summary

1. Post-Election Webinar: SIIA will host a webinar after Election Day to discuss the results and potential healthcare policies for the next two years.

2. Lame Duck Session and Funding Bill: Congress passed a short-term funding bill, setting up a high-stakes Lame Duck session focused on avoiding a government shutdown and passing key legislative measures.

3. Christmas Tree Legislation: The Lame Duck session may include a bundled "Christmas Tree Legislation" with significant healthcare provisions like PBM reforms, hospital transparency rules, and telehealth service extensions.

Recent Reports Highlight Policy Recommendations Related to Remote Patient Monitoring

By Center for Connected Health Policy - Last month, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released a new report regarding remote patient monitoring (RPM), which describes existing federal coverage policies and recent utilization rates, as well as recommending additional oversight of the telehealth modality’s use within the Medicare program. Read Full Article…

HVBA Article Summary

1. Increased RPM Usage in Medicare: OIG reported a significant rise in RPM use and payments among Medicare enrollees from 2019 to 2022, particularly for managing chronic conditions like hypertension and diabetes.

2. Concerns About Incomplete RPM Services: OIG found that 43% of enrollees didn’t receive all essential RPM components, raising concerns about proper use and potential fraud.

3. Recommendations for Better Oversight: OIG suggested requiring physician orders, improving billing safeguards, and enhancing provider education to ensure proper use of RPM services.

Can Primary Care Thrive Outside of Traditional Healthcare Players?

By Katie Adams - The past couple of years have been rocky for companies looking to disrupt the traditional primary care model — with top retailers Walmart and Walgreens announcing that they’re winding down their primary care operations significantly. Read Full Article… 

HVBA Article Summary

1. Evolving Primary Care: Nolan Chang of Kaiser Permanente stressed the need for primary care to evolve from transactional models to integrated, relationship-based care for sustainability.

2. Meeting Primary Care Demand: Ananya Banerjee from Aledade noted that disruptors must adopt value-based care to address growing demand and help independent providers thrive.

3. Patient-Centered Care: Michael Botta and Tony Farah emphasized adapting primary care to patient preferences for convenience and on-demand services, with partnerships focused on value creation.

Campbell Soup employees claim company penalizes smokers

By Charles Toutant - Campbell Soup Co. has been hit with a class action suit in New Jersey federal court, claiming that it wrongly charges employees extra for health insurance if they use tobacco products. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. ERISA Violation: The lawsuit claims Campbell Soup's tobacco surcharge violates ERISA by unfairly targeting employees based on health status.

2. Lack of Alternative Standard: The suit alleges the company failed to offer and notify employees about required alternative wellness options under ERISA.

3. No Retroactive Relief: The complaint states Campbell’s wellness program doesn’t reimburse surcharges retroactively, violating ERISA's full reward requirement.

Fox Cities Chamber announces enhanced health insurance partnership with Network Health

By staff - The Fox Cities Chamber and Network Health announced an enhanced health insurance program for 2025, exclusively for Chamber members. Read Full Article… 

HVBA Article Summary

1. Affordable Coverage: Network Health’s plan offers $0 for the first three PCP visits, preventive care, and vision exams, with low deductibles starting at $500 for individuals and $1,000 for families.

2. Prescription and Wellness: Includes $5 generic prescriptions, $25 preferred insulin before deductible, and wellness rewards through the WellnessWays program.

3. Extra Support: Offers free COBRA services, health management programs, and superior local service, with discounts available for new members and small businesses.

More than half of U.S. employees regret their open enrollment decisions, study finds

By Lucy Peterson - With open enrollment around the corner it's time for many working Americans to start making benefits selections for the upcoming year. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Regret Over Choices: Over half of U.S. employees regret last year’s benefits selections, mainly due to lifestyle changes, missed deadlines, or misunderstanding options.

2. Limited Time Spent: Employees spent just 30-60 minutes on benefits decisions, far less than the time they spend on social media daily.

3. Generational Differences: Younger workers rely more on social media for benefits info, while older employees prefer guidance from their employers.

How Are Doctors Using Tirzepatide vs Semaglutide? A Q&A

By Kelly Wairimu Davis, MS - When prescribing glucagon-like peptide 1 (GLP-1) medications, many physicians prefer tirzepatide over the more well-known semaglutide due to its superior efficacy in weight loss and A1c reduction. Studies indicated that tirzepatide can lead to greater weight loss than semaglutide. Read Full Article… 

HVBA Article Summary

1. Patient Profiles: Physicians choose tirzepatide for more significant weight loss and insulin resistance, while semaglutide is preferred for moderate weight loss goals.

2. Insurance and Availability: Insurance coverage and drug shortages heavily impact the decision between tirzepatide and semaglutide.

3. Side Effects and Efficacy: Despite trial data, tirzepatide is often reported to have fewer side effects and leads to greater weight loss, though semaglutide is favored for its cardiovascular benefits.