Medicare price cuts may have unexpected side effects

By Caroline Catherman - The Centers for Medicare and Medicaid Services (CMS) has been doing victory laps since announcing discounts on August 15 for 10 of the most expensive Medicare Part D drugs, a change that is set to go into effect in 2026. Read Full Article…

HVBA Article Summary

1. Pharmaceutical Lawsuits and Concerns: Major pharmaceutical companies including Merck, Johnson & Johnson, and Novo Nordisk have initiated legal challenges against the CMS's maximum fair prices (MFPs) introduced under the Inflation Reduction Act. These companies argue that the pricing negotiations are unconstitutional. Although no court has yet upheld these claims, the pharmaceutical industry is apprehensive about the impact of these negotiations on drug innovation and their economic bottom line.

2. Impact on Savings and Market Dynamics: Initial reports from the White House claim substantial discounts on drug prices, ranging from 38% to 79%. However, industry experts and academics, like Emma Cousin, argue that these figures might be misleading. They suggest comparing these discounts to the net prices after accounting for existing rebates and discounts to understand the true economic impact. Furthermore, there are concerns that insurance companies and drug manufacturers might offset these discounts by raising premiums and list prices respectively, potentially leading to increased costs in the private sector.

3. Effects on Pharmacies and Future Policies: The Inflation Reduction Act imposes regulations that could severely affect the profitability of long-term care pharmacies by capping the sale price of drugs at their MFPs, which are also the purchasing prices for these pharmacies. This change threatens the financial viability of these businesses, crucial for delivering medications to vulnerable populations like nursing home residents. With significant policy changes still over a year away, there is a push from various stakeholders, including the Senior Care Pharmacy Coalition, for CMS to adapt or revise policies to mitigate potential negative impacts on the healthcare system.

Employers turning to direct contracting amid rising health care costs

By Henry Craver - Rising health care costs coupled with employees' high benefit expectations are driving employers to consider direct contracting. According to a new HR Dive survey conducted by Brighton Health Plan Solutions, LLC, around 75% of employers have already considered or used direct contracting, and another 41% said they likely will by 2025. Read Full Article…

HVBA Article Summary

1. Surprising Interest in Direct Contracting: Michelle Zettergren highlighted the unexpected enthusiasm for direct contracting among benefit leaders, as revealed by a recent survey. Despite a general understanding of direct contracting, a significant portion of respondents (40%) expressed a keen interest in deepening their knowledge. This suggests a growing curiosity and potential shift towards direct contracting in the market, underscoring a discrepancy between perceived familiarity and the desire for more detailed information.

2. Employers’ Expectations and Considerations: The survey indicates that employers are motivated to adopt direct contracting primarily due to the anticipated cost savings, which most expect to be between 6% and 20%. Additionally, there is substantial interest in models that incorporate shared savings, shared risks, and emphasize quality metrics. Employers are also considering factors such as multiyear commitments, provider reputation, and geographic coverage in their contracting decisions, reflecting a nuanced approach to managing healthcare costs and quality.

3. Recommendations for Providers: Responding to the emerging trends and employer priorities, Michelle Zettergren advises healthcare providers to focus on cost reduction strategies and explore shared savings arrangements to attract direct contracting partnerships. Providers are encouraged to assess their unit costs and consider the implementation of effective medical management programs to deliver tangible savings to employers, aiming to secure long-term benefits for both parties involved.

U.S. group health insurance member months fell 3.8% in 2023

By Allison Bell - Medical expenses for enrollees in fully insured employer-sponsored group health plans increased more than for Medicaid plan enrollees in 2023 but less than for Medicare enrollees, according to a new analysis from Mark Farrah Associates. Read Full Article…

HVBA Article Summary

1. Variation in Spending Across Plan Types: In 2023, medical expenses for insured group health plans saw a significant increase of 6.1%, reaching $472 per member per month. This contrasts with the more modest 4.1% increase in spending for managed Medicaid plans, which amounted to $442 per member per month, and a higher 8.5% increase for Medicare Advantage plans, totaling $1,100 per member per month.

2. Enrollment and Premium Changes: The number of enrollees in group health insurance plans declined by 3.4% to 44.7 million by the end of 2023, with total member months also decreasing by 3.8%. Despite these declines, premiums per member per month increased by 5%, indicating a shift in how costs are being distributed among remaining members.

3. Industry Reaction and Stability: Despite the fluctuating metrics in plan performance and costs, executives from major health insurance companies expressed generally positive outlooks during their mid-year financial updates. This optimism comes amidst broader findings from the Employee Benefit Research Institute, which noted that the overall employer engagement with group health insurance and self-insurance remained stable year-over-year.

Employers: Our employees’ mental health depends on us

By Melissa Frieswick - It’s past time to take action on employee mental health. By 2030, mental disorders are projected to cause $16.3 trillion in cumulative loss in economic output. Mental disorders will affect between 25-50% of the world’s population at some point in their lives. Read Full Article…

HVBA Article Summary

1. Recognize the Longstanding Challenges and Underutilization of Benefits: While mental health issues like depression, anxiety, and burnout are not new, their intensity has been magnified by recent global crises such as COVID-19. Despite the prevalence of mental health support programs in organizations—where as many as 98% of employers offer such benefits—there's a significant gap in usage. Employees often find these benefits too complex, disconnected, or time-consuming, leading to underutilization.

2. Strategic Shifts in Mental Health Support Delivery: Employers must rethink how they deliver mental health support to overcome the challenges of fragmented services. By centralizing and simplifying access to various mental health resources, employers can enhance usability and engagement. This approach involves not just offering tools, but also integrating these tools into a coherent system that employees can easily navigate.

3. Building a Supportive Culture and Tailored Care: Beyond structural changes, there is a critical need for fostering a workplace culture that actively supports mental health. This means leadership must be visibly committed and proactive, not only in providing resources but also in engaging with employees authentically. Tailoring support to meet the diverse needs of the workforce—considering factors like job type, personal circumstances, and specific mental health challenges—can make support more accessible and effective.

A benefits expert's advice: View healthcare as an investment, not an expense

By Lee Hafner - Building a robust health benefits package on a budget is a daunting task. But armed with options and the right outlook, employers can better accommodate the needs of a dynamic workforce. Peter Freska, a partner at fintech and insurance firm Acrisure, works to understand companies' employee populations — who they are, what kinds of offerings they value, ways to help them stay healthy long term — and craft their benefits accordingly. Read Full Article…

HVBA Article Summary

1. Holistic Approach to Profitability: Freska emphasizes that profitability extends beyond financial gains; it involves investing in the workforce through education, training, and development. This broader perspective of profitability is especially vital for small and medium-sized businesses, which make up 99% of U.S. companies, as they strive to balance budget constraints with the desired benefits to ensure long-term success.

2. Strategic Advisory Role: As an adviser, Freska cultivates close relationships with employers, ranging from family-owned businesses to large corporations, to guide them through making well-informed decisions about employee benefits. His proactive communication strategy includes regular emails, phone calls, and personal visits, ensuring that he effectively conveys the best options available in the market for employee benefits, cyber liability, payroll, and commercial risks.

3. Enhancing Employee Well-being: Freska advocates for removing barriers to healthcare access as a means to boost employee well-being and productivity. By proposing changes like eliminating copays for primary care and offering unlimited access to telehealth and mental health services, he aims to ensure that preventative care is more accessible, reducing the likelihood of severe health issues among employees. This approach is part of his broader view of employee health as a crucial investment, rather than just an expense.

How Aon Partnered with Minnesota Firefighters to Create Crucial Health Benefits

By AON - Firefighters face a unique set of risks in the work they do. In addition to the obvious risk of serious injury in a fire, they also face long-term health consequences. The most serious of these risks revolve around three main areas: cancer, cardiac health and emotional trauma. Read Full Article…

HVBA Article Summary

1. Firefighters' Health Risks: Firefighters are exposed to significant health risks associated with their profession. They face a 14 percent higher risk of dying from cancer compared to the general population due to exposure to smoke and carcinogens. Cardiac health issues are also prevalent, often triggered by the physical demands of firefighting. Additionally, the emotional toll of the job is severe, with a disturbingly high number of firefighters experiencing suicidal thoughts and attempts.

2. Creation of MnFIRE: In response to these critical health challenges, George Esbensen, a seasoned fire chief from Minnesota, co-founded MnFIRE in 2016. This organization aims to directly address and mitigate the health risks that firefighters endure. A significant part of its mission is to support volunteer firefighters, who constitute about 90% of Minnesota's firefighting force and typically do not have health benefits through their volunteer roles.

3. Hometown Heroes Assistance Program: Through strategic partnerships and legislative efforts, MnFIRE helped establish the Hometown Heroes Assistance Program, which provides critical illness coverage and other support mechanisms for firefighters. This program includes a 24/7 support hotline for emotional and mental health crises and conducts training programs focused on awareness and risk reduction. Since its inception, the program has trained over 17,500 firefighters and processed numerous critical illness claims, demonstrating its effectiveness and impact on the firefighter community in Minnesota.

Intermittent Fasting Aids Patients With Prediabetes or T2D

By Dr. Philippe Teller - Intermittent fasting is a method for addressing excessive calorie intake by alternating between periods of eating and fasting. During the fasting period, which can last for 12-16 hours, all food is prohibited. This approach essentially requires the patient to skip at least one meal, and several variations of the approach are possible. Read Full Article…

HVBA Article Summary

1. Comparison and Effectiveness: Intermittent fasting, being less severe than prolonged fasting, offers a viable alternative with a favorable risk-benefit profile. According to a recent meta-analysis, intermittent fasting significantly improved several markers of metabolic health in adults with prediabetes or type 2 diabetes. This included notable reductions in body weight, body mass index (BMI), A1c levels, and fasting blood glucose levels when compared to a controlled but nonhypocaloric diet.

2. Methodology of Meta-Analysis: The study synthesized data from 14 methodologically sound trials involving 1101 adult patients, utilizing sources like PubMed, Web of Science, and Scopus. The researchers employed a random effects model to calculate weighted mean differences (WMDs) between intermittent fasting and other dietary control methods such as calibrated or hypocaloric diets, ensuring each participant served as their own control.

3. Long-term Viability and Comparison with Hypocaloric Diets: Intermittent fasting showed a lower but still significant weight loss compared to hypocaloric diets. The method also displayed stable benefits in metabolic markers which suggests its potential as a long-term dietary strategy. However, the lack of significant effects on other health parameters such as blood pressure and plasma lipids highlights the need for individualized dietary planning and monitoring.

5 key voluntary benefits to watch in 2025

By Dawn Kawamoto - Open enrollment is fast approaching, and the vast majority of employers will once again offer a range of voluntary benefits to help their workforce leverage benefits to fit their specific needs—all with the goal of avoiding increased organizational spending. Read Full Article…

HVBA Article Summary

1. Integration and Customization: Voluntary benefits, traditionally seen as add-ons, are now being integrated with core benefits on the same administrative platform. This integration simplifies enrollment and enhances customization for employees, addressing gaps in existing coverage plans. Richard “Rae” Egleston of Gallagher notes that this leads to improved mental and financial well-being for employees and cost savings for employers through enhanced utilization and satisfaction.

2. Rising Popularity and Innovation: The demand for voluntary benefits is growing, with 67% of employers looking to expand these offerings according to a recent Gallagher study. The interest spans across diverse workforces and includes popular benefits like supplemental health, legal services, and cybersecurity protection. These benefits are evolving to include coverage for broader and more specific needs such as mental health support, family-forming journeys, and personal cybersecurity.

3. Impact on Employee Retention and Satisfaction: Offering a wide range of voluntary benefits is increasingly seen as crucial for employee retention and satisfaction. With 86% of employers viewing these benefits as vital to their wellbeing strategies, and a significant portion of employees willing to switch jobs for better benefits, these programs not only support employees’ diverse needs but also foster loyalty and contribute to a positive workplace culture.

Ozempic Curbs Hunger – And Not Just for Food

By F. Perry Wilson, MSCE, MD - If you've been paying attention only to the headlines, when you think of "Ozempic" you'll think of a few things: a blockbuster weight loss drug or the tip of the spear of a completely new industry — why not? A drug so popular that the people it was invented for (those with diabetes) can't even get it. Read Full Article…

HVBA Article Summary

1. Broadening Impacts of GLP-1 Receptor Agonists: Beyond their primary use in managing obesity, GLP-1 receptor agonists like Ozempic have shown potential in influencing a range of consumption-related behaviors. Research indicates these drugs may reduce not only calorie intake but also excessive behaviors such as alcohol consumption, cannabis use disorders, and compulsive shopping, suggesting a wider anticonsumption effect.

2. Emerging Evidence in Smoking Cessation: A recent non-randomized study highlighted by the Annals of Internal Medicine suggests that Ozempic may aid in smoking cessation among people with diabetes. This study, which used medical records to emulate a target trial, found that patients on Ozempic were significantly more likely to quit smoking compared to those on other antidiabetes medications, indicating an unexpected benefit of this drug on modulating addictive behaviors.

3. Potential Mechanisms and Caveats: The effectiveness of Ozempic in these additional roles may stem from its action on brain circuits related to reward and gratification, which are also implicated in various addictive behaviors. However, the reliance on administrative health records and diagnostic codes introduces limitations, as it may not capture all nuances of smoking behavior changes. Further research, particularly well-controlled trials, is necessary to fully understand and confirm these broader impacts.