The No Surprises Act left out ground ambulances. Here’s what’s happening now

By Laura Santhanam - Minutes after Lainey Arebalo gave birth to her third child last September, hospital staff noticed her son was having trouble breathing. They recommended placing the infant in an ambulance so he could receive care at a better-equipped pediatric facility 23 miles away. Within days of receiving that extra care, Avebalo was able to bring her healthy baby home where their waiting family welcomed him. Read Full Article…

VBA Article Summary

1. The Growing Issue of Surprise Ambulance Bills: A few weeks after giving birth, Arebalo, a special education teacher in San Luis Obispo County, California, was shocked to receive a bill for $4,400 for her son's ambulance ride. Her insurer didn’t cover transportation from the only ambulance company in her county. This dilemma isn't unique; one in ten non-elderly privately insured individuals have no way of knowing the cost of an ambulance ride. Despite 13 states moving to protect patients from such surprise bills, there remains a lack of national protection.

2. The System's Complexities and Outdated Rules: Ambulance services operate under a patchwork of rules and responsibilities that vary by jurisdiction. Charges can be based on mileage, the severity of physical trauma, or whether or not the service is in-network for insurance. In states like California, more than two-thirds of ambulance rides include out-of-network services, exposing patients to surprise bills. Many of these regulations trace back to policies from the 1960s when Medicare was introduced, resulting in a system that often doesn't align with a patient's holistic needs.

3. The Push for Change and Hope for a Solution: Congress created the Ground Ambulance and Patient Billing Advisory Committee to examine and address these complexities. With public input being sought, the committee intends to deliver recommendations by November. The core challenges include determining the applicability of surprise billing protections and considering the suspension of in-network versus out-of-network ambulance distinctions during emergencies. With public demand for answers intensifying, there's optimism that meaningful action is on the horizon. However, patients like Arebalo continue to face the financial hardships of the current flawed system.

The AI x HR collaboration—teaming up with machines

By Jill Barth - The relationship between HR leaders and technology is constantly evolving, but not everyone is ready for a commitment. A June 2023 report from Mercer shows that around 30% of organizations plan to use AI in recruiting efforts over the next 12 months, but very few of them said they are “fully prepared” for teaming up with machines. Read Full Article… 

VBA Article Summary

1. Preparedness and Compliance with AI in HR Systems: Many HR systems have integrated AI tools for years, and their misuse is increasingly being brought to light through lawsuits. Notably, in 2020, the Equal Employment Opportunity Commission (EEOC) filed a lawsuit against iTutorGroup due to their AI hiring system that screened out certain age groups based on gender, resulting in a $365,000 settlement. Regardless of technological advancements, the responsibility to comply with employment regulations rests with people, emphasizing the importance for HR professionals to be well-informed about the tools, systems, and algorithms they use.

2. Emerging HR Tech Innovations: Skillsoft has launched the beta version of the CAISY Conversation AI Simulator, which assists users in practicing business interactions under the guidance of an AI coach. This is a reflection of how AI is being utilized to enhance soft skills and interpersonal relations in the workplace. In another innovative move, Roblox introduced its Career Center platform, aiming to tap into a younger demographic already familiar with their gaming environment, indicating the fusion of entertainment platforms with career opportunities.

3. Trends and Insights from HR Tech Experts: The role of technology in HR decisions is ever-growing, as evidenced by the Human Resource Executive's 2023 Top 100 HR Tech Influencers list. Insights from experts like Morey Haber caution about the use of bots in targeting new hires via LinkedIn. On the constructive side, Dr. Christian Schmeichel highlights the potential of algorithms in identifying skill gaps and suggesting relevant training. The rise in unique functionalities offered by learning tech vendors from 2021 to 2023, as pointed out by Dani Johnson, further underscores the rapid evolution in HR technology.

AARP urges court to uphold drug price negotiation program

By Brendan Pierson - AARP, the leading lobbying group for older Americans, on Friday urged a federal judge not to block a new law that for the first time gives Medicare the power to negotiate drug prices with pharmaceutical companies in response to a lawsuit by business groups. Read Full Article…

VBA Article Summary

1. AARP's Opposition to Blocking Negotiations: AARP has filed a legal document in federal court in Dayton, Ohio, arguing against the U.S. Chamber of Commerce's request to block negotiations on drug pricing. AARP contends that halting the program would hinder Congress's efforts to reduce drug prices, thereby harming older Americans, especially Medicare recipients. They cite a study showing that about 20% of Medicare beneficiaries couldn't afford their prescribed treatments.

2. The Chamber of Commerce's Lawsuit and Drugmakers' Challenges: In its lawsuit, the Chamber of Commerce argues that the drug pricing program, part of President Joe Biden's Inflation Reduction Act, violates drugmakers' due process rights by allowing the government to dictate maximum prices. The law has also faced similar challenges from drugmakers like Merck & Co and industry groups. These challengers are seeking court orders to prevent scheduled negotiations over certain high-priced drugs, slated to begin later this year, with new prices to be effective in 2026.

3. Current Status of the Case: The case, titled Dayton Area Chamber of Commerce et al v Becerra et al, is pending in the U.S. District Court, Southern District of Ohio. So far, no court has made a ruling on the requests to halt the negotiation process, and the Chamber of Commerce has not immediately responded to requests for comment. Representation for the various parties involved has been provided by legal firms and the U.S. Department of Justice.

What the hospital-at-home movement tells us about igniting innovation in health care

By James B. Rebitzer and Robert S. Rebitzer - As a health care economist who studies innovation, and as a management consultant who helps health systems and insurers adopt new technologies, we have had a ringside seat to a frustrating phenomenon: The large private sector of the U.S. health system can move faster to adopt valuable innovations than the public sector burdened by red tape and politics. But before adopting an innovation at scale, the private sector too often waits for the public sector to take the first step — sometimes for decades. Read Full Article…

VBA Article Summary

1. Historical Resistance and Recent Emergence: The concept of "hospital at home" has been around since the 1970s but gained traction only after the Acute Hospital Care at Home Waiver was introduced by the Centers for Medicare and Medicaid Services (CMS) during the Covid-19 pandemic in November 2020. This move, in part influenced by the aging baby boomer population and the cost implications of building new hospitals, marked the beginning of a growing movement towards the adoption of the model, even post the public health emergency's end in March 2023.

2. Economic Dilemma and the Common-Agency Problem: The adoption of the hospital-at-home model entails significant upfront investments in processes, technologies, and specialized personnel. The financial barrier arises when no single payer feels their patient volume justifies the significant reimbursements needed to support the hospital-at-home costs. This issue, termed as the "common-agency problem" in economics, hinders the large-scale adoption of valuable health innovations. The introduction of the Acute Hospital Care at Home Waiver, however, addressed this issue by guaranteeing reimbursements for the hospital's investments, thus incentivizing private payers to also support the model.

3. Strategies to Drive Healthcare Innovation:

   Jump-starting: A significant commitment from a key payer, such as CMS, can serve as the spark needed to encourage innovation.

   Information Sharing: Collaborative groups, like the Hospital at Home Users Group, enable innovators to share best practices and methods, streamlining the model's implementation.

   Reducing Uncertainty: Making policies, like the Acute Hospital Care at Home Waiver, permanent can further speed up the adoption process by minimizing uncertainties.

   Building Consensus: Gaining endorsements and favorable reports from renowned organizations, such as the American Hospital Association and the Society of Hospital Medicine, establishes trust and advocacy for novel innovations amongst both providers and the general public.

4 Strategies to Set Young Employees Up for Open Enrollment Success

By CBIZ - Open enrollment can be confusing for employees of all ages. However, for younger members of the workforce, navigating this complex process can be especially daunting. In fact, 26% of Gen Z employees are insecure about making benefits decisions, according to a study conducted by MetLife. Read Full Article…

VBA Article Summary

1. The Importance of Basic Benefits Education: New employees, particularly younger ones, might not only be unfamiliar with how to navigate open enrollment but might also not comprehend its significance or the role of benefits. Hence, before diving deep into the enrollment procedure, it's vital to educate them about the foundational aspects of benefits: what they are, why they are crucial, and how to avail them. Keeping communications clear, free of jargons, and accessible can make a big difference in employee understanding and participation.

2. Diversifying Benefits Beyond Health Insurance: When thinking about open enrollment, most employees, especially the younger ones, primarily think of health insurance. However, there's a broader range of voluntary benefits available. The younger workforce often has different priorities when it comes to benefits, such as valuing mental health resources or student loan support over traditional offerings like life insurance. Therefore, educating them about a broader range of benefits that cater to their needs can lead to higher engagement.

3. Promote a Methodical Open Enrollment Process: Hurrying through open enrollment can lead to oversight or poor choices, especially among young employees who might be unfamiliar with the process. Employers should give ample time for benefit selection, remind them of deadlines through various means, and encourage questions. Continuous communication, ensuring they know where to seek guidance, whether from HR or experienced peers, can help them make informed decisions. Regular and clear communication throughout the year emphasizes the importance of benefits and aids in better decision-making.

Many Americans relying on insurance they haven’t bought to pay for old-age care

By Steve Randall - Survey reveals how people believe they will cope in their senior years, and the gaps that exist. As America’s population ages, more people are likely to need long-term care in their retirement years and advisors need to bring up that conversation. Read Full Article… 

VBA Article Summary

1. Misunderstanding of Long-Term Care Insurance Coverage: The Nationwide Retirement Institute Long-Term Care survey found that there is a significant discrepancy in the understanding of long-term care insurance. While 18% of respondents claimed to have this insurance (including 27% of millennials), industry data shows that fewer than 3% actually do. Many Americans, especially millennials, mistakenly believe they have long-term care coverage, often confusing it with long-term disability insurance or standard health insurance.

2. Need for Financial Advisor Involvement: The survey emphasizes the vital role financial professionals must play in educating and assisting clients with long-term care insurance. Though 51% of respondents consider speaking to financial advisors about long-term care insurance important, only 18% report having long-term financial planning advice. Advisors are encouraged to be proactive in helping families plan for these important issues and ensuring that clients are indeed protected.

3. Concerns Over Financial Burden and Legacy Impact: The results of the survey also reveal underlying fears regarding aging and financial dependency. Around half of the respondents are worried about becoming a burden to their family as they age, and 26% are concerned that paying for long-term care will reduce their children’s inheritance. These concerns underscore the importance of proper understanding, planning, and preparation for long-term care needs.

Voluntary benefits: Four ways the industry is innovating

By Keith Farley - Advancements in technology and medical research have always shaped the need for innovation in insurance. But the COVID-19 pandemic made it obvious that health care can change rapidly and, health insurance must quickly adapt as well. For this reason, innovations in both product and experience are some of the most important investments an insurer can make. Four key areas where digital innovation is most necessary include product, preventive care, enrollment and claims experience. Read Full Article…

VBA Article Summary

1. Product Innovation Influenced by Medical Advancements: The link between customer experience and benefits design is becoming more pronounced due to advancements in technology, AI, and healthcare. As medical treatments evolve (e.g., pill-based chemotherapy, immunotherapy, telemedicine), insurance providers must continuously adapt and innovate their product offerings. Insurers need to keep abreast of medical research and treatment trends, ensuring comprehensive coverage irrespective of the mode of treatment.

2. The Significance of Benefits Enrollment and Education: The initial interaction individuals have with their insurance benefits is typically during the enrollment phase. Despite technological advancements, a significant number of enrollments are not digital, creating a gap in employers' perception of employee understanding and the reality. While virtual consultations and online chats are prevalent, the importance of personal consultations and face-to-face discussions can't be overlooked. These interactions foster better comprehension and confidence in employees regarding their benefits choices.

Americans feeling the growing burden of health care, costs

By Joel Kranc - Four distinct issues covered in the survey results highlight specific aspects of American health care that are falling short. The good news is that three-quarters of Americans rate their health as good, according to a new Healthlock Attitudinal Research survey. The bad news is that there are still serious issues plaguing Americans around health care. Four distinct issues covered in the survey results highlight specific aspects of American health care that are falling short. Read Full Article…

VBA Article Summary

1. Challenges Faced by Surveyed Americans:

   Overwhelmed Segment (30%): Feel inundated by medical bills and are concerned about their accuracy, seeking simpler payment methods. They are stressed by the time spent managing these bills and are anxious about affording medical emergencies within the family.

   Anxious Segment (23%): Feel nervous about issues such as identity theft, medical identity theft, and health insurance billing fraud. They are wary of online security and the associated risks of sharing health information online.

   Fix the System Segment (24%): Believe that the health insurance system should be more supportive in saving money rather than complicating bill payments. They stress the need for insurance to manage medical expenses and insist health information should be private among patients, doctors, and insurance firms.

   Proactive Segment (23%): Have faith in their health as a protective factor against healthcare costs and are confident in planning for healthcare expenses. They believe in taking proactive steps to minimize costs.

2. Perception of Health and Insurance: A majority, 54% of respondents, place high importance on physical health and wellbeing. Among these, the “proactive” and “fix the system” segments especially deem their health of extreme importance. Over one-third feel their health is very good or excellent, with “proactive” respondents leading this statistic. Around 50% feel their health care needs match those of their peers, but the overwhelmed group feels their healthcare needs are greater than their peers. A significant 93% have health insurance, but the overwhelmed segment is less likely to have it. Out of those with insurance, 78% rate their policy as good or excellent, and again, the proactive segment is more inclined to rate their coverage as excellent.

3. Insights on Health Savings and Financial Accounts: Only 24% of respondents utilize health savings tools such as HSA, FSA, or HRA. The data suggests these financial vehicles could be underutilized or less understood among the general population, presenting an area for further exploration and potential policy improvement.