New cybersecurity bill is a step in the right direction, but we can’t stop here | Viewpoint

By Steve Cagle - The Health Infrastructure Security and Accountability Act (HISAA), introduced in the U.S. Senate last month, is a big step forward in addressing the monumental cybersecurity challenges the healthcare sector faces. Read Full Article… 

HVBA Article Summary

1. Strengthening Cybersecurity Standards Across the Sector: The HISAA bill introduces minimum cybersecurity standards for healthcare organizations and business associates, with enhanced requirements for entities critical to national security. This aims to address existing gaps in cybersecurity practices, which have left many organizations vulnerable to ransomware attacks and data breaches.

2. Increased Accountability and Risk Management: The legislation requires top executives, such as CEOs and CISOs, to attest to compliance with security standards, making senior leaders accountable for their organization's cybersecurity posture. It also mandates third-party audits and annual HHS assessments to ensure adherence to these standards.

3. Support for Underserved Healthcare Organizations: Recognizing the financial constraints faced by smaller healthcare providers, HISAA allocates $1.3 billion in funding to help rural and urban safety net hospitals enhance their cybersecurity measures. However, the funding may not be sufficient, and ongoing support and incentives are needed for these organizations to meet the new requirements.

How EviCore’s "Denials-for-Dollars" Model is Putting Americans' Health at Risk

By Wendell Potter - Every day in America, thousands of patients get notices from their health insurers that the treatments their doctors say they need will not be covered because it is not, in the opinion of the insurance company, “medically necessary.” Read Full Article…

HVBA Article Summary

1. Outsourcing Medical Necessity Decisions: Insurers like Cigna have outsourced medical necessity determinations to companies like EviCore, creating a "denials for dollars" model that prioritizes profit over patient care. This results in increased denial rates for necessary treatments through prior authorization processes.

2. Algorithm Manipulation and Denial Rates: EviCore uses an algorithm called “the dial” to assess treatment coverage, enabling it to manipulate thresholds and boost denial rates. In some states, denial rates can reach nearly 20%, significantly hindering patient access to care.

3. Patient Impact and Industry Criticism: The focus on financial savings over patient health leads to confusion and frustration among patients, who are often unaware of the external review process affecting their care. This lack of transparency fosters distrust in the healthcare system, as profit-driven entities make critical decisions about necessary treatments.

CGMs Aren’t Just for People with Diabetes Anymore, Dexcom COO Says

By Katie Adams - The U.S. spends $413 billion dollars each year on diabetes-related care, meaning that diabetic patients now account for one of every four healthcare dollars spent in the country. Read Full Article… 

HVBA Article Summary

1. Increased Awareness and Education: Dexcom's COO, Jake Leach, emphasizes the importance of raising awareness about metabolic health. Educating individuals on how to manage their glucose levels can empower them to make healthier choices, potentially preventing diabetes or its progression.

2. Introduction of Stelo for Broader Access: Dexcom has launched Stelo, an over-the-counter continuous glucose monitoring (CGM) device designed for adults not taking insulin. This innovation provides an affordable option for tracking glucose levels, giving access to those with prediabetes and others interested in monitoring their metabolic health.

3. Real-Time Monitoring Benefits: The Stelo device enables users to see real-time fluctuations in their glucose levels throughout the day. This information helps individuals understand how their food, activity, and stress impact their metabolic health, promoting better management and healthier lifestyle choices.

Cost of giving birth? $17,990 in 2023, FAIR Health finds

By Lucy Peterson - Employers are continuing to spend more on bringing people to life. The median cost of a birth at employer plans and other commercial payers increased to $17,990 in 2023, according to FAIR Health, a health care cost data organization. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Cost Increases: The 2023 median birth-related costs rose by 3.8% compared to 2022 and by 14% compared to 2020, with the presence of complications adding an average of $3,938 to overall expenses.

2. Impact of Diabetes: Expecting mothers with preexisting diabetes faced significantly higher median birth-related costs—$9,125 more—than those without complications. Approximately 2.5% of mothers in 2022 had preexisting diabetes, while 11% developed gestational diabetes during their pregnancies.

3. Demographic Trends: The average age of mothers increased to 31.7 years from 2020 to 2023, with 19.7% classified as obese in 2023, factors contributing to higher healthcare spending during pregnancy.

10 worst and best states for healthcare access

By Deanna Cuadra - With record healthcare costs and medical debt, the U.S. is infamous for its poor healthcare access — but the level of access can differ drastically from state to state. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Western States Dominate Poor Access Rankings: Five Western states, including Utah, Nevada, and Arizona, are among the top 10 states where healthcare is least accessible. Utah tops the list with a score of 100, reflecting a low number of primary care physicians and hospital beds per 1,000 residents.

2. Key Factors Impacting State Scores: The study evaluated 14 metrics, such as hospital beds per 1,000 residents, uninsured rates, annual deductibles, and community health centers. Higher scores indicated worse healthcare access, with Utah and Nevada particularly struggling with provider availability.

3. Best-Performing States Offer Better Coverage: States with the lowest scores, like Massachusetts, Connecticut, and Rhode Island, tend to have higher numbers of primary care physicians and lower percentages of uninsured residents. Massachusetts scored a perfect 0, with only 2.4% uninsured and about 23 primary care physicians per 1,000 residents.

Employer-sponsored health coverage persists post-ERISA

By Alan Goforth - Although most workers today take employer-sponsored health coverage for granted, it really didn't become a widespread benefit until as recently as World War II. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Historical Context: Employers' commitment to health benefits began during World War II due to wage controls and tax regulations, solidified by ERISA, which provided a consistent regulatory framework.

2. Trends in Coverage: The share of the non-elderly population with employment-based health coverage declined from 70% to 60% between 1970 and 2023, with a significant drop in small employers offering benefits, while large employers have increased their offerings.

3. System Resilience: Despite predictions of decline from the Affordable Care Act, the employment-based health coverage system remains strong, with stable eligibility rates largely due to large firms. Future focus should be on addressing disparities between small and large employers.

Skipping Medicare drug coverage now can mean paying more later when you do sign up

By Liz Weston - Dear Liz: I did not enroll in Part D prescription coverage when I enrolled in Medicare in 2005 because I was not taking any prescriptions at the time. When I enrolled a few years later, I was penalized $11 per month for late enrollment and I must pay this penalty until I die. Read Full Article… 

HVBA Article Summary

1. Insurance Logic and Medicare Payments
   Insurance companies, including Medicare, operate on a risk-pooling model where premiums paid by healthier individuals help offset the costs of healthcare for sicker individuals. This system prevents premium prices from rising excessively, which would occur if only those with high medical needs purchased insurance.

2. Reviewing Living Trusts
   It's advisable to review living trusts with an attorney every three to five years, or following significant life changes such as marriage, divorce, changes in financial status, or relocation. Regular updates ensure that the trust reflects current asset ownership and remains effective in fulfilling your estate planning goals.

3. Social Security Survivor Benefits Eligibility
   Survivor benefits can be claimed by a surviving spouse of any age if they are caring for a child who is under 16 or a disabled child. Otherwise, eligibility for survivor benefits typically starts at age 60, or at age 50 if the surviving spouse is disabled.