Daily Insurance Report - August 1, 2023

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

New Study Reveals Generational Differences in Workplace Benefits Priorities

LIMRA and EY study recommends employers invest in digitalization to better personalize and deliver benefits for workers of different generations

By LIMRA - With four generations in the workforce, understanding the unique benefits priorities of the various age groups and having the ability to personalize benefits communications and deliverables is key to successfully recruiting and retaining workers. Read Full Article… 

VBA Article Summary

  1. Changing Workforce Demands: The report by LIMRA and Ernst & Young LLP emphasizes that most employers (61%) believe they need to provide a wider range of benefits to meet the varying expectations of different generations in their workforce. This is particularly in light of the increase in demand for nonmedical benefits, such as paid family medical leave, emergency savings, and financial wellness programs. This change in demands comes after the pandemic-induced shift towards hybrid and remote work, reshaping the landscape of employee benefits. These benefits serve as key tools for employers to attract and retain talent in a highly competitive job market.

  2. Diverse Benefits Preferences Across Generations: The research affirms that while traditional employer-paid services and products, such as medical insurance, paid family leave, and life insurance, will continue to form the core of benefits packages, there's a growing expectation for more holistic offerings. Younger employees increasingly value benefits that promote wellbeing, encompassing mental, physical, and financial health. This includes interest in mental health treatment, physical wellness benefits, tuition and student loan assistance, and caregiving benefits. Employers, especially smaller ones, will need to balance creating a comprehensive benefits package with their budget constraints, possibly offering more employee-paid benefits to meet demand.

  3. Digitalization of Benefits Communication: One of the main challenges employers face is that employees often lack an understanding of the benefits they offer. With diverse needs across the workforce, it's necessary for employers to tailor their communications to engage and educate employees from different generations effectively. Most workers, over 90%, feel that this guidance can be delivered successfully through digital channels. Younger generations show the most interest in using mobile apps for accessing benefits information. In response to these changing preferences, employers will likely need to update their technology and rely more heavily on third-party technology in the future. This includes tools provided by insurance carriers, brokers, technology vendors, and benefits administration and enrollment firms.

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What employers need to know about "guided use" of cannabis

By Brooke Worster, M.D. - While much stigma and confusion around cannabis use still remains (especially for those who grew up in the 80’s “Just Say No” era), the fact is that cannabis is now legal in most states. Ninety-four percent of U.S. adults live in a state where medical cannabis is legal, and more than 50% live in a state where both medical and recreational use is legal. Read Full Article… 

VBA Article Summary

  1. Changing Views and Laws Regarding Cannabis Use: With legal cannabis sales in the U.S. estimated at around $33B, a third of which is spent on health and medical purposes, societal views towards cannabis are evolving. This is particularly apparent among the Gen Z and Millennial workforce. Outdated employer policies on cannabis use might hinder employees who are either recommended or choose to use it for various reasons. Hence, there is a need for employers to adapt and provide guidance for safer and more appropriate use.

  2. The Growing Medicinal Use and Different Consumption Methods of Cannabis: Cannabis has been demonstrated to provide relief for various conditions like cancer and treatment-related symptoms, Parkinson’s, chronic pain, poor sleep, and anxiety. As such, its use is expanding. Furthermore, inhaling cannabis through smoking or vaping is becoming less common, giving way to safer consumption methods like cannabis oils, edibles, or transdermal patches. These provide the benefits of cannabis without the potential harm of inhaling substances into the lungs.

  3. The Need for Clinically Guided Use of Cannabis and the Role of Employers: Current users often lack professional guidance on dosage, frequency, and interaction with other medications, which can lead to potentially dangerous consequences. Employers have a chance to intervene by ensuring the safe and guided use of cannabis, especially for employees who need to reduce their usage due to health and wellness concerns. This could range from offering access to guidance services to covering the cost of such services. Proper guidance on the use of cannabis is crucial for maintaining safety in the workplace while recognizing its potential benefits.

Why workers in small businesses can struggle with mental health and ‘presenteeism’

By Jane Suter, and Annie Louise Irvine - Most of the knowledge on supporting mental health in the workplace is based on the experience of larger organisations that typically have a lot of staff to handle these issues. IF YOU are struggling with your mental health, is it better to come to work or stay off sick? You may think your employer would prefer you try to keep working, but many employers would prefer you take time off to feel better. Read Full Article… 

VBA Article Summary

  1. Challenges and Unique Features of Small Businesses: Small businesses can offer an appealing work environment due to their intimate, family-like atmospheres and close working relationships. However, they often lack the formal resources and expertise of larger organizations. Limited access to human resource management, occupational health services, and staff capacity are common. Moreover, these small firms may find it challenging to offer flexibility or reassign roles for employees dealing with mental health issues.

  2. The Rising Importance of Mental Health in the Workplace Post-Pandemic: The COVID-19 pandemic has brought increased attention to the mental health and well-being of employees, amplifying the necessity of addressing these issues in the workplace. Unfortunately, the majority of existing knowledge and strategies to support workplace mental health are derived from experiences of larger organizations, which typically possess more extensive resources and personnel to manage these issues.

  3. Significance of Small Businesses in the Global Economy: Despite their constraints, small businesses are not to be underestimated; they make up a substantial portion of the global economy. In the UK, for instance, small businesses employing fewer than 50 people account for half of the private-sector employment. Therefore, the importance of enhancing mental health support and resources in small businesses is not just a matter of employee well-being but also a crucial aspect of economic health and resilience.

Value in Health Care Act of 2023 Introduced to Congress to Reinforce Value-Based Care

By Briana Contreras - The Value in Health Care Act of 2023, a bipartisan legislation that would make several important reforms to ensure alternative payment models (APMs) continue to produce high quality care for the Medicare program and its beneficiaries, was introduced in a letter signed by seventeen of the nation’s leading stakeholders in healthcare. Read Full Article… 

VBA Article Summary

  1. Introduction and Support for the Value in Health Care Act of 2023: Seventeen leading stakeholders in healthcare, including the National Association of ACOs (NAACOS) and the American Medical Association, have expressed support for a bipartisan House bill - the Value in Health Care Act of 2023. This legislation is set to bolster Medicare’s transition to value-based care, following the Value in Health Care Act of 2021, which aimed to reform methodologies and components within the Medicare Shared Savings Program. The 2023 Act proposes several important reforms to ensure the continued delivery of high-quality care for Medicare beneficiaries via alternative payment models (APMs).

  2. Key Provisions of the Act: Among its improvements to the Centers for Medicare & Medicaid Services (CMS)’s value-based care programs, the Value Act of 2023 plans to extend the 5% advanced APM incentives by two years, give CMS the authority to adjust thresholds to secure incentive payments, and eliminate the revenue-based distinction disadvantaging rural and safety net providers. Furthermore, it aims to establish a more transparent process for setting financial spending targets, thus preventing ACOs from being penalized for their success, create a voluntary track for ACOs to take on higher levels of risk, and provide technical assistance to clinicians new to APMs. The Act also proposes studying ways to increase parity between traditional Medicare APMs and Medicare Advantage.

  3. Impact of the Act on Accountable Care Organizations (ACOs): According to NAACOS, ACOs have produced over $17 billion in gross savings for Medicare over the past decade and have improved care quality for millions of patients. The Value Act of 2023 is anticipated to further augment these improvements by providing more opportunities for rural, underserved, primary care or specialty practices to engage in APMs, and by promoting more fairness and transparency in financial target setting. This would ultimately lead to further improvements in access to care and health equity.

Global Dental Anesthetics Market To Record Healthy Expansion At 5.3% By 2029

By Xherald - Witnessing an average Y-o-Y growth of ~5% in revenues, the global dental anesthetics market is set to reach the US$ 1 billion market, by 2020. Hospitals will remain the cornerstone of the promising growth outlook of the dental anesthetics market, according to a recent study of Fact. MR. The report suggests that half of the overall sales of dental anesthetics is accounted for by hospital pharmacies, whereas a third of the total dental anesthetics consumption is registered by hospitals. Read Full Article… 

VBA Article Summary

  1. Expansion and Advancements in Dental Anesthetics Market: The global dental anesthetics market has seen a significant growth due to advancements in technology and a rise in demand for painless operations. These advancements have increased precision and reduced pain during surgeries, leading to higher adoption of dental anesthetics by healthcare providers globally. Factors contributing to this growth include increased spending on dental treatments due to higher disposable income, greater awareness of oral health, and a rise in dental tourism.

  2. Insurance Coverage and Regulatory Impact: The expansion of commercial insurance coverage and policies like the Patient Protection and Affordable Care Act of 2010 have significantly reduced out-of-pocket expenses for patients. By providing information to consumers about various options and plan choices, these policies have fostered a more organized and competitive market for health insurance, thus promoting the growth of the dental anesthetics market.

  3. Geographic Market Trends: North America continues to dominate the global dental anesthetics market due to higher per capita spending on oral care and healthcare. However, regions like Europe and Asia Pacific also present lucrative growth opportunities. The growth in Europe is driven by significant R&D investments in the dental care industry, particularly in countries like the UK and Germany. Meanwhile, Asia Pacific offers potential growth due to factors like easy labor availability, lower land costs, and rapidly developing economies like China and India showing a surge in dental surgeries.

Audit Highlights Medicaid MCOs’ High Rates of Prior Authorization Denials

By David Raths - A federal audit of Medicaid managed care organizations (MCOs) found thatone out of every eight requests for the prior authorization of services in 2019 was denied, and that most state Medicaid agencies did not routinely review the appropriateness of a sample of MCO denials. Read Full Article…

VBA Article Summary

  1. Concerns Raised by the Office of Inspector General (OIG) Report: The July 2023 report from the OIG at the U.S. Department of Health & Human Services expressed concerns over the high denial rates of prior authorization requests by Managed Care Organizations (MCOs) providing Medicaid services. This concern was based on three factors: the high number and rates of denied prior authorization requests, the limited oversight of these denials in most states, and the limited access to external medical reviews. The report further highlighted that allegations have surfaced suggesting inappropriate delays or denials of care by some MCOs, particularly affecting vulnerable patients, such as those with cancer, heart conditions, the elderly, and those requiring in-home care and medical devices.

  2. Comparative Analysis with Medicare Advantage: The OIG report made a comparative analysis with Medicare Advantage, a program where oversight of denial decisions is notably more robust. CMS reviews a sample of prior authorization denials every year and mandates health plans to report denial and appeal data. Moreover, Medicare Advantage enrollees have access to automatic external medical reviews of denials. These disparities in oversight and external review availability between Medicaid and Medicare Advantage raise concerns about health equity and access to care for Medicaid managed care enrollees.

  3. Recommendations by the OIG and CMS Response: The OIG provided a set of recommendations to the Centers for Medicare and Medicaid Services (CMS), such as requiring states to review the appropriateness of a sample of MCO prior authorization denials regularly, necessitating states to collect data on MCO prior authorization decisions, and implementing automatic external medical reviews of upheld MCO prior authorization denials. The report also suggested that CMS should work with states to identify and address MCOs that may be issuing inappropriate prior authorization denials. While the CMS concurred with the last recommendation, it did not provide a clear response to the first four recommendations.

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Regulators warn hospitals and telehealth companies about privacy risks of Meta, Google tracking tech

By Heather Landi - Federal regulators are warning hospital systems and telehealth providers about the data privacy risks of using third-party tracking technologies. These services, like Meta Pixel or Google Analytics, could violate the Health Insurance Portability and Accountability Act (HIPAA) or Federal Trade Commission (FTC) data security rules, officials said. Read Full Article… 

VBA Article Summary

  1. Increasing Concerns Over Health Data Privacy and Security: The FTC and the U.S. Department of Health and Human Services' Office for Civil Rights (OCR) issued a rare joint release warning 130 hospital systems and telehealth providers about the potential privacy and security risks of online tracking technologies integrated into their websites or mobile apps. These technologies, including Meta/Facebook Pixel and Google Analytics, could be impermissibly disclosing consumers’ sensitive personal health data to third parties, often without the users' knowledge. The agencies encouraged the providers and companies to conduct a privacy and security check-up to ensure their compliance with applicable laws.

  2. Previous Studies Highlighting Risks: Previous investigations by The Markup and a study published in Health Affairs detected prevalent use of online tracking technologies on hospital websites, potentially leading to HIPAA violations. These instances and the associated concerns led the FTC and OCR to reiterate the risks posed by unauthorized disclosures of personal health information, which could have serious negative impacts, including identity theft, financial loss, and potential discrimination.

  3. Legal Implications and Recent Actions: Regardless of whether a company is covered by HIPAA, it still has an obligation under the FTC Act and the FTC Health Breach Notification Rule to protect against impermissible disclosures of personal health information. This holds true even for digital health companies that used third-party design services for their websites or apps. The FTC recently fined several companies for allegedly violating the Health Breach Notification Rule and proposed changes to the rule to protect consumer data privacy. The situation has resulted in several health systems, like Advocate Aurora Health and WakeMed Health and Hospitals, facing patient-led class-action lawsuits related to data sharing through website trackers.

J&J joins pharma allies in challenging US drug pricing law

By Kristin Jensen - The U.S. has long been the most lucrative market for pharmaceutical makers, in part because there are no mechanisms such as price negotiations to control the cost of medicines. As a result, Americans pay more than three times as much for brand-name drugs than people in other parts of the world, according to a 2021 Rand Corporation study funded by the U.S. government. Read Full Article…

VBA Article Summary

  1. Johnson & Johnson's Challenge: Janssen Pharmaceuticals, Johnson & Johnson's pharmaceutical unit, has filed a lawsuit against a new law aimed at reducing prescription drug prices, the Inflation Reduction Act (IRA). The company claims the law infringes on its constitutional rights, specifically the Fifth Amendment, which prohibits the confiscation of private property for public use without fair compensation. J&J argues that the law's provision for Medicare to negotiate drug prices effectively equates to property confiscation, as it believes the resulting prices will be dictated rather than negotiated equitably.

  2. Impact on Research and Development: In its suit, J&J highlights the potential long-term effects of the law on the industry's research and development efforts. The company has spent $65.7 billion on R&D since 2016, and it believes the law will deter further investment into new and existing drugs by disrupting the current market-based pricing model. This, J&J contends, will ultimately harm patients by reducing access to innovative medicines and improvements to existing therapies.

  3. Industry-Wide Opposition: Janssen Pharmaceuticals is not alone in its stance against the IRA. Other pharmaceutical companies including Bristol Myers Squibb, Merck & Co., and trade group Pharmaceutical Research and Manufacturers of America have also filed lawsuits in different federal courts to fight the law. Astellas Pharma has similarly challenged the law, terming it "not only bad policy, but unconstitutional." The collective pushback from these pharmaceutical giants underscores the industry's significant opposition to the legislation, and the potential legal hurdles the law faces.