Daily Industry Report - September 27

Your summary of the Voluntary and Healthcare Industry’s most relevant and breaking news; brought to you by the Health & Voluntary Benefits Association®

Jake Velie, CPT
Vice Chairman & President
Health & Voluntary Benefits Association® (HVBA)
Editor-In-Chief
Daily Industry Report (DIR)

Robert S. Shestack, CCSS, CVBS, CFF
Chairman & CEO
Health & Voluntary Benefits Association® (HVBA)
Publisher
Daily Industry Report (DIR)

Mark Cuban to employers: Save millions with 1 move

By Paige Twenter - Large companies can save millions of dollars by addressing one common misconception about health insurance plans, according to billionaire entrepreneur Mark Cuban. Read Full Article… 

HVBA Article Summary

  1. Transparency in the Industry: Cuban views the FTC's lawsuit against PBMs as a positive step toward increasing transparency in the pharmaceutical industry, which he believes is currently opaque and favors larger PBMs.

  2. Misconceptions about PBMs: He highlights a common misconception among employers that PBMs save money and add value to healthcare. Instead, he argues that companies often become reliant on rebates, which prevents them from accurately auditing their costs and accessing complete claims data.

  3. Switching to Pass-Through PBMs: Cuban advocates for employers to transition from traditional PBMs to pass-through PBMs, suggesting that this change can significantly enhance cost savings and improve employee health outcomes by providing better access to data and more control over formulary management.

HVBA Poll Question - Please share your insight

What do you think is the most important step to improve healthcare cybersecurity?

Login or Subscribe to participate in polls.

Our last poll results are in!

60.81%

of Daily Industry Report readers who responded to our last polling question, when asked what they believe the most significant impact would be if travel were offered as a benefit with an optional employer contribution/match, “ stated, “use as a recruiting tool when competing for top talent.”

22.14% responded the most significant impact of travel benefits would be to “Offer employees rewards & recognition,” and 11.71% believe it would “encourage vacation time to increase retention & engagement”. In comparison, 5.34% believed the most significant impact would be to “mitigate PTO financial Risk - reduce financial risk on the books by dropping PTO into 401(play) travel benefit accounts.”

Have a poll question you’d like to suggest? Let us know!

Should CFOs Look Into Medical Debt Relief?

By Marie Defreitas - Medical debt is no small issue within the American healthcare system. It often becomes a burden for patients and makes them hesitate to seek future care. Read Full Article…

HVBA Article Summary

  1. Prevalence and Disparity of Medical Debt: A KFF analysis reveals that 41% of U.S. adults carry medical debt, with lower-income families, parents, and Black and Hispanic adults disproportionately affected.

  2. Innovative Debt Relief Initiatives: Advocate Health is taking a significant step by canceling judgment liens on homes and forgiving debts associated with these liens, aligning with a broader movement in North Carolina to relieve medical debt for Medicaid patients through enhanced reimbursement incentives for participating hospitals.

  3. Potential Benefits for Health Systems: Implementing debt relief strategies can enhance patient relationships, improve satisfaction and engagement, streamline administrative operations, and potentially stabilize revenue over time, particularly as the healthcare industry shifts toward value-based care focused on patient outcomes.

Register Today On Us - Space is Limited

HHS calls for stricter oversight of remote patient monitoring

By Naomi Diaz - HHS is calling for increased oversight for remote patient monitoring as its use within Medicare has increased in recent years. Read Full Article… 

HVBA Article Summary

  1. Significant Adoption with Gaps in Service: Between 2019 and 2022, there was a notable increase in remote patient monitoring adoption among Medicare enrollees; however, nearly 43% of users did not receive all three essential components of the service, raising concerns about its effectiveness.

  2. Concerns About Fraudulent Activities: Both the Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS) expressed worries about potential fraudulent practices in remote patient monitoring, prompting closer scrutiny of its implementation and adherence to guidelines.

  3. Recommendations for Enhanced Oversight: The OIG proposed several recommendations for CMS, including implementing safeguards for appropriate billing, mandating detailed claims data related to ordering providers, developing methods to track monitored health data, conducting provider education on billing practices, and identifying companies for increased accountability in remote patient monitoring billing.

2024-2025 compliance calendar: self-funding checklists and deadlines

By Andrea Bailey Powers, Elverine F. Felton, and William E. Robinson - As employers and their benefits advisors look toward open enrollment for their group health plans, now is a good time to review action items needed for those plans by year-end, as well as upcoming deadlines in the near future. Read Full Article… (Subscription required)

HVBA Article Summary

  1. Updated HIPAA Requirements for Reproductive Healthcare: Employers must update their HIPAA privacy policies and train staff on new regulations regarding the handling of protected health information (PHI) related to reproductive healthcare by December 23, 2024. This includes ensuring that no PHI is disclosed without appropriate authorizations and that workforce members understand when an attestation is needed.

  2. Annual Gag Clause Attestation: By December 31, 2024, all group health plans must file an annual attestation confirming that no "gag clauses" apply to the plan. Self-insured plan sponsors should ensure that their third-party administrator (TPA) is compliant in submitting this attestation.

  3. Compliance with Mental Health Parity and Transparency Regulations: Starting January 1, 2026, new regulations will enforce non-quantitative treatment limitations (NQTLs) for mental health and substance use disorder benefits, requiring employers to provide necessary data for compliance. Additionally, self-insured health plans must comply with the No Surprises Act and ensure transparency in fee disclosures and cost-sharing information starting January 1, 2024.

California Governor Signs Law Banning Medical Debt From Credit Reports

By Molly Castle Work - Californians with medical debt will no longer have to worry about unpaid medical bills showing up on their credit reports under legislation signed Tuesday by Gov. Gavin Newsom, adding the nation’s most populous state to a growing effort to protect consumers squeezed by unaffordable medical bills. Read Full Article…

HVBA Article Summary

  1. Protection Against Medical Debt Reporting: California’s new law, backed by Sen. Monique Limón and Attorney General Rob Bonta, will prevent healthcare providers and collection agencies from reporting patients' medical debt to credit reporting agencies. This measure aims to alleviate the financial burden on individuals who face unexpected medical expenses, which disproportionately impact low-income and marginalized communities.

  2. Loopholes and Exemptions: Despite the protective measures, the legislation includes a significant loophole where debts incurred through medical credit cards or specialty loans are not exempt from credit reporting. This concession, influenced by the financial industry, raises concerns about the potential for patients to face high-interest debt without adequate consumer protections.

  3. Wider Implications of Medical Debt: The inclusion of medical debt in credit reports can severely impact individuals’ financial stability, affecting their ability to secure loans, jobs, and housing. Personal testimonies highlight the real-life consequences of medical billing errors and the stress associated with debt, emphasizing the need for robust protections against such financial pitfalls.

Once-Weekly Insulin: A Game-Changer for Primary Care

By Kevin Fernando - Presented at the European Association for the Study of Diabetes (EASD) 2024 congress in Madrid, the QWINT-2 study established that once-weekly dosing of insulin efsitora was as effective as once-daily dosing of insulin degludec for reducing A1c in patients with type 2 diabetes (T2D) who had not previously received insulin. Read Full Article…

HVBA Article Summary

  1. Impact on Patient Compliance and Care: The introduction of once-weekly insulin simplifies the administration process for patients, reducing the number of required injections from 365 to just 52 per year. This significant reduction is expected to improve patient compliance, especially for those with injection anxiety, and potentially enhance glycemic control while minimizing the risk of complications associated with Type 2 Diabetes (T2D).

  2. Benefits for Healthcare Providers: For clinicians, the ease of once-weekly dosing can alleviate therapeutic inertia, making it easier to initiate insulin therapy without the burden of intensive follow-up. This could lead to earlier intervention in managing T2D, ultimately reducing the risks associated with delayed treatment. Additionally, it may lessen the workload on community nursing staff, who could see a decrease in the number of necessary home visits.

  3. Challenges and Considerations: While the once-weekly insulin presents several advantages, questions remain regarding its management during acute illnesses or "sick days." Clinicians will need to determine whether dose titration is necessary during these periods and how best to integrate other insulin regimens if needed. Continued education and guidance from specialist diabetes teams will be essential to address these uncertainties effectively.

Employer group calls for pharmacy benefit managers to be fiduciaries

By Allison Bell - The ERISA Industry Committee, a group for employers with self-funded benefit plans, says Congress should make pharmacy benefit managers fiduciaries. Read Full Article… (Subscription required)

HVBA Article Summary

  1. Fiduciary Responsibilities of Employers: Employers that are members of the ERIC group act as fiduciaries for their self-insured health plans, which means they are legally required under the Employee Retirement Income Security Act (ERISA) to act in the best interest of plan participants and to help control costs.

  2. Proposal for PBM Fiduciary Status: ERIC has proposed that Congress consider making Pharmacy Benefit Managers (PBMs) fiduciaries by expanding the definition of fiduciary under ERISA. This change would impose the same fiduciary duties on PBMs that currently apply to employer health plan sponsors, potentially enhancing protections for plan participants against high drug prices and hidden fees.

  3. Ongoing Regulatory and Legislative Battles: The push to classify PBMs as fiduciaries comes amid ongoing scrutiny and regulatory actions from the Federal Trade Commission regarding PBM practices, particularly related to insulin pricing. This initiative is part of a broader movement by the U.S. Labor Department to increase fiduciary responsibilities across various sectors, including a contentious debate over fiduciary duties for annuity sellers.