Healthcare reform fades from election spotlight

By Mackenzie Bean - Healthcare reform, once a central issue in elections, has taken a back seat in this year's presidential race, The New York Times reported Sept. 13. Read Full Article…

HVBA Article Summary

1. Lack of Focus on Healthcare Reform: Despite high drug prices and reproductive rights being prominent issues for both Donald Trump and Kamala Harris, neither candidate has prioritized healthcare insurance reforms in their campaigns. This absence marks a significant departure from previous elections, where health reform was central.

2. Stability in the Healthcare Landscape: The current healthcare environment is more stable, with the ACA markets having settled and a low uninsured rate. This stability has shifted voter concerns towards other issues like immigration and the cost of living, leading candidates to avoid the politically sensitive topic of healthcare reform.

3. Potential Future Implications: The minimal focus on healthcare during the campaign does not preclude significant policy changes in the future. Experts suggest that the stakes in healthcare could remain high, indicating that the lack of discussion now may not reflect the candidates' future intentions.

Cigna’s Express Scrips Sues FTC Over Drug Pricing Report

By Seeking Alpha - Cigna's pharmacy benefit manager Express Scripts has filed a lawsuit against the FTC over the agency's recent report on PBMs, which highlighted their contribution to soaring drug prices in the U.S. Read Full Article…

HVBA Article Summary

1. Legal Action by Express Scripts: Express Scripts has petitioned a federal court in St. Louis to compel the Federal Trade Commission (FTC) to retract its recent report and to seek the recusal of FTC Chair Lina Khan from any actions against the company.

2. Key Findings of the FTC Report: The FTC's July report revealed that the six largest pharmacy benefit managers (PBMs), including Express Scripts, CVS Health, UnitedHealth, and Humana, dominate the market, controlling nearly 95% of all prescriptions filled in the U.S. due to significant vertical integration and market concentration.

3. Background of the Investigation: The FTC's findings stem from a comprehensive two-year investigation into the business practices of PBMs, aiming to assess their impact on drug pricing and competition in the pharmaceutical industry.

Why more companies should brace for ERISA lawsuits

By Deanna Cuadra - For many Americans, health insurance doesn't guarantee they will be able to afford care without risking their financial stability. Some workers are taking steps to shake up the status quo. Read Full Article… _{(Subscription required)}

HVBA Article Summary

1. Class Action Lawsuits Under ERISA: This year, employees from Johnson & Johnson and Wells Fargo filed class action lawsuits against their employers, claiming violations of fiduciary duties under the Employee Retirement Income Security Act (ERISA). The lawsuits argue that the companies failed to select appropriate prescription drug plans and neglected their responsibilities in negotiating drug prices and administrative fees.

2. Fiduciary Responsibilities: Under ERISA, employers must uphold two primary fiduciary duties: the duty of loyalty, which mandates acting in the best interests of plan members, and the duty of prudence, which requires careful and diligent decision-making. Legal experts predict an increase in lawsuits as employees seek to hold employers accountable for these obligations.

3. Need for Transparency and Monitoring: Experts advise employers to reevaluate their health plans and partners to ensure compliance with ERISA standards. Red flags include low employee engagement, insufficient access to claims data, and high emergency room visits. As more cases emerge, employers have the opportunity to enhance their health plans for the benefit of both the business and its workers.

Generative AI Set To Revolutionize Insurance Market, Forecast To Hit $14.4B by 2032

By Captive.com - The global generative artificial intelligence (AI) in insurance market, valued at $761.4 million in 2022, is projected to surge to $14.4 billion by 2032, growing at a compound annual growth rate (CAGR) of 34.4 percent from 2023 to 2032, according to a report by Allied Market Research. Read Full Article…

HVBA Article Summary

1. Transformative Impact of Generative AI: Generative AI is revolutionizing the insurance industry by enabling personalized policy recommendations and more efficient risk assessment models, significantly enhancing the digital experience for policyholders and improving decision-making processes.

2. Market Growth Drivers: Key factors fueling market expansion include faster claims processing, enhanced customer service, and improved risk assessment capabilities. The adoption of explainable AI (XAI) is also contributing to growth by providing transparency in AI-driven decisions.

3. Segment Analysis and Trends: In 2022, the solution segment dominated the market, driven by the need for processing large data volumes and offering personalized services. The service segment is projected to grow rapidly at a CAGR of 36.5%, while generative adversarial networks (GANs) and diffusion networks are leading technology trends, supporting fraud detection, underwriting, and complex data modeling.

CMS Wants Feedback on Impact of AI in Healthcare

By Derrick Henry - The Centers for Medicare and Medicaid Services is soliciting information on current artificial intelligence capabilities that could enhance its program executions. Read Full Article… 

HVBA Article Summary

1. Request for Input on AI Technologies: CMS has issued a request for information to gather insights from healthcare companies, providers, payers, and tech startups on AI technologies that can enhance workforce capabilities and improve operational efficiency within the agency.

2. Focus Areas for Submissions: Submissions should highlight the impact of various AI functionalities in healthcare, including generative AI, diagnostics, imaging analysis, business automation, workforce enablement, patient communication, robotic-assisted delivery, and fraud detection, along with addressing associated risks and benefits.

3. Demonstration Opportunity: Selected organizations will have the chance to showcase their AI products at "CMS AI Demo Days," where they will collaborate with CMS's technical panel to present their solutions in a 15-minute format. Interested parties must submit questions by Sept. 27 and capability statements by Oct. 7.

Coffee's 'Sweet Spot': Daily Consumption and Cardiometabolic Risk

By F. Perry Wilson, MSCE, MD - Each and every day, 1 billion people on this planet ingest a particular psychoactive substance. This chemical has fairly profound physiologic effects. Read Full Article…

HVBA Article Summary

1. Cardiovascular Benefits: Research indicates that moderate coffee consumption (around 3-5 cups a day) is associated with a significant reduction in cardiovascular disease risk, with studies showing nearly a 40% decrease in risk among high consumers compared to non-drinkers.

2. Metabolomic Insights: The recent study analyzed metabolites in participants' blood samples and found that coffee intake positively influences several metabolites linked to heart health, including reductions in harmful VLDL cholesterol and saturated fatty acids, suggesting a potential causal pathway for cardiovascular protection.

3. Holistic Perspective: While coffee and caffeine offer notable health benefits, it's important to differentiate between healthy coffee consumption and sugary or high-calorie coffee beverages, emphasizing moderation and awareness of overall dietary choices.

What does "employee engagement" even mean?

By Chris Reed - As you read this, an under-pressure CFO somewhere is walking into the office of their HR benefits leader asking tough questions about employee engagement with the company's health care benefits. Read Full Article… _{(Subscription required)}

HVBA Article Summary

1. Defining Meaningful Engagement: For effective measurement and improvement, the industry must adopt a shared definition of "engagement" that goes beyond superficial interactions. This definition should focus on meaningful connections that genuinely impact employees' health care journeys, incorporating both digital and in-person interactions.

2. Importance of a Unified Navigation System: Implementing an independent health care navigation platform is crucial. This system provides employees with a single access point to their health benefits, facilitating personalized interactions and ensuring they receive the right care at the right time. This approach enhances engagement and supports better health outcomes.

3. Addressing the Engagement Gap: Despite recognizing the importance of employee engagement, many employers struggle with measurement and implementation. By prioritizing meaningful engagement and utilizing effective navigation tools, organizations can bridge the engagement gap, ultimately leading to improved employee satisfaction, retention, and productivity while managing rising health care costs.