Daily Insurance Report - August 3, 2023

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

NIH begins long-delayed clinical trials for long Covid, announces new research office

By Rachel Cohrs - The National Institutes of Health on Monday took long-delayed steps to begin enrolling patients in clinical trials to test long Covid treatments, and the Department of Health and Human Services created an Office of Long Covid Research that the Biden administration first announced nearly a year ago. Congress in December 2020 gave the NIH $1.15 billion to research and test treatments for long Covid. The trials were initially supposed to launch last fall but were delayed three separate times, according to documents obtained by STAT and MuckRock. Read Full Article… 

VBA Article Summary

  1. Paxlovid Trials for Viral Persistence: Duke University is conducting a new trial testing Pfizer's antiviral Paxlovid to see if a longer regimen can alleviate symptoms of viral persistence. This comes after a previous trial at Stanford University was halted early due to interim results. The officials in charge at Duke plan to test Paxlovid over a longer duration than Stanford did, emphasizing that different interventions may lead to varying results in different populations.

  2. Trials for Brain Fog and Sleep Issues: Several Phase 2 trials will address symptoms like brain fog and sleep disturbances. The brain fog trials, which are set to launch in the coming weeks, will test brain training software and a home-based stimulation device, including between 100 and 300 patients per trial. Trials focusing on sleep issues are planned in the next "two to three months," and will test two wakefulness-promoting drugs, melatonin, light therapy, and educational coaching.

  3. Trials for Heart Rate, Breathing, and Digestive Symptoms: Other areas of focus in the coming trials will include symptoms affecting heart rate, breathing, and digestive activity. These trials will evaluate treatments such as intravenous immunoglobulin therapy and ivabradine, a drug used to treat chronic heart failure with elevated heart rate. Details on additional drugs to be tested were not provided in the information.

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Rural Communities in the US Struggle with Healthcare Costs and Access

By Sandeep Kunchikor - A recent survey by the Commonwealth Fund reveals that people in rural communities in the United States are more likely to skip healthcare due to high costs compared to their counterparts in other high-income countries. In fact, nearly 40% of rural adults reported foregoing necessary medical care because they couldn’t afford it. This percentage is significantly higher than in countries like Australia and Norway. Read Full Article… 

VBA Article Summary

  1. The Impact of Government Regulation on Healthcare: The article outlines the negative consequences of previous governmental interventions, like Obamacare, which were intended to guarantee universal health insurance. These regulations led to unexpected consolidation within the healthcare sector, resulting in higher costs and inefficiencies, contrary to the intended effect of increasing efficiency and lowering prices. This highlights the complex nature of government intervention in healthcare and suggests that solutions may need to consider different approaches.

  2. Effects on Rural Communities: The article emphasizes the particularly severe impact of healthcare consolidation on rural communities. The merging of hospitals and insurers into larger entities has led to the closure of vital services in rural areas. Large healthcare conglomerates find it more profitable to consolidate services in urban areas, leading to reduced competition and healthcare access in rural communities. This underscores the need for policies that address the unique needs of rural areas, rather than a one-size-fits-all approach.

  3. Proposed Solutions: In response to the problems identified, the article suggests specific policy measures. These include undoing the preferential treatments given to consolidated care under Obamacare, repealing “certificate of need” laws that restrict competition, and loosening regulatory requirements. By discouraging consolidation and empowering rural communities to find healthcare solutions tailored to their unique needs, these measures aim to create a more flexible and responsive healthcare system.

Offering Vital Healthcare Services In The Post-COVID Era: What Every Employer Should Know

By Kelly Bliss - The needs of today’s workforce are rapidly evolving, especially following the mental and physical tolls the pandemic took on every individual. A recent employer survey uncovered that 88% of employees are currently experiencing or anticipate experiencing long-term mental health issues (e.g., depression, anxiety, Substance Use Disorder, stress management), and 70% of employers are currently experiencing or anticipate experiencing higher chronic condition management needs. Knowing that chronic illnesses may increase one’s likelihood of developing a mental health condition, these numbers are staggering and may potentially lead to larger public health concerns. Read Full Article… 

VBA Article Summary

  1. The Need for Treating Mental and Physical Health Together: The article emphasizes the inextricable link between mental and physical health. Treating them in tandem is essential for long-term health goals and preventing serious chronic conditions. An integrated whole-person care experience is proposed, offering virtual care services in one place, including chronic care, mental health, and primary care. This makes navigation easier for employees and allows providers to personalize care based on readily available health data and insights.

  2. Seamless Integration for Consumer Engagement: Focusing on the user experience, the article illustrates the process of managing a chronic condition like diabetes and how an integrated care system works in real time. This approach uncovers issues proactively and engages users with appropriate mental health support without putting the burden on them to seek help. It also provides tools and connections between different health coaches to ensure that care is coordinated and personalized to the individual's needs.

  3. Outcome-Driven Solutions with Virtual Care: The last part of the article underlines the urgency of implementing effective, personalized, and seamless virtual care solutions to drive long-term improvements. Using data and machine learning, the article shows significant results among the population, such as greater improvement in blood sugar levels, weight loss, and reduced blood pressure levels. The focus is on outcomes, reflecting a whole-person care approach that works, with the aim of offering convenient, comprehensive healthcare to employees.

Companies 'ill-prepared' to meet newly adopted SEC cybersecurity rules

By Hugo Guzman - The "prevailing norm" in corporate America is "governance is lacking, resources are misaligned, and enterprises fly blind to their most critical cybersecurity risks, putting the company and shareholders on uncertain ground," said Scott Kannry, CEO of the cyber-risk engineering firm Axio. The U.S. Securities and Exchange Commission on Wednesday finally adopted stringent new cybersecurity disclosure rules for public companies, 16 months after the agency proposed them. Read Full Article… 

VBA Article Summary

  1. New Disclosure Requirements: The ruling mandates that companies must publicly disclose a breach within four days of determining that it was material. It also requires that companies annually disclose their cybersecurity risk-assessment strategy, the cybersecurity expertise of management, and provide updates on previously disclosed cybersecurity events. The new rules aim to create more transparency for investors and standardize the way cybersecurity information is shared, but they are to be implemented almost immediately, creating a challenge for compliance.

  2. General Unpreparedness Among Companies: Despite the lead time given, many experts, including industry leaders such as George Gerchow of Sumo Logic, believe that most companies are ill-prepared to meet the four-day reporting requirement. CEOs and boards must be more proactive, gaining a stronger grasp of cybersecurity risks and implementing governance similar to other major organizational risks. The current norms starkly contrast with these requirements, with many companies lacking proper governance and alignment of resources for cybersecurity.

  3. Potential Controversies and Concerns: The new rules have been met with both support and criticism. SEC Chair Gary Gensler expressed that the rules would benefit both companies and investors by standardizing disclosures. However, dissenting voices such as Commissioner Hester Peirce argue that the SEC may be overstepping its authority, and that providing such transparency could inadvertently aid cybercriminals by offering insights into company vulnerabilities. The rules passed on a partisan vote, reflecting a division in viewpoints on the best approach to handling corporate cybersecurity. Additionally, the SEC hasn’t yet disclosed what the penalties for noncompliance will be, adding to the uncertainty surrounding the new requirements.

Everything old is new again? The latest round of health policy proposals reprises existing ideas

By Julie Appleby - Forget "repeal and replace," an oft-repeated Republican rallying cry against the Affordable Care Act. House Republicans have advanced a package of bills that could reduce health insurance costs for certain businesses and consumers, partly by rolling back some consumer protections. Rather than outright repeal, however, the subtler effort could allow more employers to bypass the landmark health insurance overhaul’s basic benefits requirements and most state standards. 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.

14 recent state legislative actions supporting site-neutral payments

By Jakob Emerson - As calls continue for expanded use of site-neutral payment policies, many states have recently enacted legislation aiming to protect consumers from unknown or high facility fees from providers, according to a July 21 analysis from the National Conference of State Legislatures. Read Full Article…

VBA Article Summary

  1. Legislation and Notifications Regarding Facility Fees: Connecticut, Colorado, Maryland, and New York have passed laws requiring written notice of facility fees. Florida mandates signs displaying average facility fees in freestanding emergency departments. Indiana has introduced requirements for hospitals to report facility fee revenues. Several states have taken further specific measures such as Colorado's establishment of a study committee, and Connecticut's expansion of outpatient services that cannot charge facility fees.

  2. Restrictions and Prohibitions on Facility Fees: Colorado and New York have banned facility fees for preventive services. Texas has outlawed facility fees at drive-thru healthcare facilities. Specific limitations on facility fees have also been placed in Connecticut, Ohio, and Washington for telehealth visits, with varying applications.

  3. Move Toward Site-Neutral Payment Policies: Site-neutral payment policies aim for consistent pricing across different settings. According to the NCSL, several states have embraced laws to support these policies. These measures reflect a trend in regulation aimed at transparency and consistency, with an emphasis on protecting patients, employers, and payers from unexpected or inconsistent costs.

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Exponential Growth Expected for Online Healthcare Enrollment Platforms Market With Complete SWOT Analysis by Forecast From 2023 to 2030 | eHealth, HealthSherpa, GetInsured, GoHealth, Connecture

By Coherent Market Insights - A comprehensive review Online Healthcare Enrollment Platforms report focusing on each and every side effect of COVID-19 on new products, pipeline analysis, supply chain overview, government policies, customer-related strategies, as well as vaccines and drug status, which could ultimately affect the company in the long run. These market strategies are analyzed by studying the impact of different social, political, and economic factors as well as the current market impact on the development of the COVID-19 Online Healthcare Enrollment Platforms market. Read Full Article… 

VBA Article Summary

  1. Segmental Analysis and Forecast (2023-2030):

    • Objective: The study aims to evaluate the Online Healthcare Enrollment Platforms market sizes in different segments & countries, focusing on recent years and predicting values for the years to come.

    • Qualitative and Quantitative Aspects: The report integrates both qualitative and quantitative factors of the industry to provide a balanced insight into the market's growth.

    • Factors Influencing Growth: Various trends, restraints, and drivers are analyzed in the report, helping readers understand the forces that have a positive or negative impact on the market.

  2. Regional Analysis and Coverage:

    • Five Major Regions: The report offers detailed overviews of the Online Healthcare Enrollment Platforms market in North America, Europe, Asia-Pacific, South America, and the Middle East & Africa.

    • Key Countries: Specific focus on countries such as the United States, Canada, Mexico, Germany, France, United Kingdom, Japan, Korea, India, Brazil, Argentina, Saudi Arabia, UAE, and Egypt.

    • Qualitative and Quantitative Data: Regional insights include a mix of both qualitative and quantitative information, ensuring a comprehensive view of the market in these areas.

  3. Global Market Outlook:

    • Revenue Analysis: The segmental analysis emphasizes revenue and forecasts by type and application, giving an in-depth look at where the market is heading.

    • Strategic Insights: The report is structured to offer strategic insights into the industry by incorporating different aspects that contribute to the market's growth.

    • Potential Growth Areas: By understanding different regions and market segments, the report can guide businesses and stakeholders in identifying potential areas for growth and investment in the global Online Healthcare Enrollment Platforms market.

Acquitted LifeBrite CEO sues 6 payers for $1B over alleged 'smear campaign'

By Andrew Cass - The CEO of a laboratory company acquitted in a $1.4 billion fraud scheme is suing six payers, alleging they made false allegations to regulators and prosecutors to avoid paying millions in legitimate claims. Read Full Article… 

VBA Article Summary

  1. Accusation and Acquittal: Christian Fletcher, CEO of LifeBrite Laboratories, along with nine others, was accused of a billing scheme involving approximately $1.4 billion in laboratory claims to private insurance companies from November 2015 to February 2018. The defendants were allegedly paid $400 million for these claims. However, a jury acquitted Mr. Fletcher in March of conspiracy to commit healthcare fraud, wire fraud, and money laundering.

  2. Lawsuit Against Insurance Companies: A lawsuit filed in Georgia state court claims that various insurance companies, including Blue Cross Blue Shield of Florida, Blue Cross and Blue Shield Healthcare Plan of Georgia, Elevance Health, Anthem Insurance, UnitedHealth Group, and CVS Health/Aetna, intentionally destroyed LifeBrite's business and reputation. This has allegedly resulted in damages exceeding $1 billion. The lawsuit asserts that the payers conspired to portray LifeBrite's relationship with hospitals as healthcare billing fraud and leverage relationships to prosecute and destroy the lab.

  3. Seeking Justice: Mr. Fletcher and LifeBrite Laboratories are seeking a jury trial and demanding over $1 billion in damages. The lawsuit, represented by the law firm Miller Barondess LLP, aims to hold the insurance companies accountable for falsely and maliciously attacking the laboratory's business practices, despite being in accordance with federal law.