Best’s Market Segment Report: AM Best Maintains Stable Outlook on U.S. Health Insurance Market Segment

By Business Wire - AM Best is maintaining its stable outlook on the U.S. health insurance market segment for 2024, noting its continued favorable earnings, the positive impact of interest rates on investment-related financial results, in addition to growth in the Medicare Advantage (MA) business. Read Full Article…

VBA Article Summary

1. Underwriting Income and COVID-19 Impact: The U.S. health insurance industry experienced flat underwriting income in the first half of 2023, a departure from the rising trend seen in previous years, as reported in AM Best’s Market Segment Report. This stagnation is attributed to the COVID-19 pandemic's effects, which initially reduced healthcare utilization and boosted operating results. However, as COVID-related impacts lessened in 2023, there was an increased demand for certain procedures, especially in the Medicare Advantage (MA) segment, leading to higher utilization rates. Despite this, the MA segment continued to be profitable.

2. 2024 Outlook and Cost Management Strategies: Looking ahead to 2024, the health insurance industry is expected to face narrowing margins as the profitability of government programs like Medicaid managed care and MA returns to more typical levels. Insurers have seen higher-than-normal earnings in these areas over the past few years, contributing to overall industry profitability. In response, health insurers are focusing on cost control measures, including directing care to high-quality/low-cost locations and using value-based care models aimed at improving patient health outcomes.

3. Innovative Approaches for Cost Reduction: Health insurers are implementing strategies to control costs and encourage plan adoption, such as offering financial incentives for members to choose cost-effective care locations. They are complementing these strategies with the use of narrower networks, which are expected to significantly impact trend-related rate increases over time. These efforts, as highlighted by Sally Rosen, senior director at AM Best, demonstrate the industry's commitment to balancing cost control with patient choice and care quality.

Purdue Pharma, Sacklers' OxyContin settlement lands at the Supreme Court

By Nina Totenberg - The opioid crisis comes to the Supreme Court Monday as the justices hear arguments in a challenge to the bankruptcy deal meant to compensate victims of the highly addictive pain killer OxyContin. Read Full Article…

VBA Article Summary

1. Purdue Pharma Settlement and the Sackler Family's Role: Purdue Pharma, recognized for its production and misleading marketing of Oxycontin, agreed to pay billions in a court-approved deal to address the harms of the opioid epidemic. This agreement also controversially shields the Sackler family, who owned and operated Purdue, from personal liability. The company's and the Sacklers' roles were initially obscure but have since been thoroughly documented in various media, including the documentary "Crime of the Century."

2. Details of the Bankruptcy Deal and Opposition: In 2020, Purdue Pharma admitted guilt to three criminal charges and was fined $8 billion, mostly payable to state and local governments managing the opioid crisis's impact. The bankruptcy deal, central to this case, includes a $4 billion contribution from the Sacklers, later increased to $6 billion after some states objected. However, the deal also controversially absolves the Sackler family and their associates from further liability, a point contested by U.S. Trustee William Harrington and others, who argue that bankruptcy law does not support such third-party releases.

3. Debate Over the Settlement's Fairness and Implications: Critics, like Georgetown Law professor Adam Levitin, argue that the settlement allows the Sacklers to avoid full accountability and retain significant wealth, contradicting the principle of bankruptcy providing relief to honest debtors. On the other hand, proponents like Columbia Law professor Edward Morrison highlight the pragmatic aspects of the deal, emphasizing the challenge of retrieving hidden overseas assets and the importance of promptly compensating victims. The Supreme Court's impending decision on this matter raises questions about the scope of bankruptcy courts' authority and the potential consequences of overturning the deal.

AI is driving Google’s health care business. Washington doesn’t know what to do about it.

By Ruth Reader - Google wants to make your cell phone a “doctor in your pocket” that relies on the company’s artificial intelligence. But first, the tech giant will need to convince skeptical lawmakers and the Biden administration that its health AI isn’t a risk to patient privacy and safety — or a threat to its smaller competitors. Read Full Article…

VBA Article Summary

1. Google's Aggressive Move into AI-Enabled Health Care: Google is actively deploying its AI technology in the health care sector, scanning medical records, research papers, and clinical guidelines to assist doctors in disease diagnosis and treatment evaluation. Despite concerns from regulators and competitors about patient privacy and market dominance, Google has already formed partnerships with major health care providers like the Mayo Clinic and is exploring direct-to-consumer applications. Senator Mark Warner has expressed concerns about the premature use of Google's AI in hospitals without sufficient vetting, emphasizing the potential risks to patient data and the reinforcement of human biases.

2. Regulatory and Ethical Challenges: There's a growing concern among lawmakers, such as Senator Warner, and regulatory bodies like the Food and Drug Administration (FDA) regarding the unregulated use of advanced AI in health care. The FDA, which currently approves AI-enabled medical devices, lacks specific rules for software-based AI tools. Google is not waiting for regulatory frameworks and is proceeding with its AI initiatives. The Biden administration has tasked agencies to ensure AI in health care is beneficial, but comprehensive rules may be years away. Meanwhile, Google is hiring former government health care regulators to influence policy-making in its favor.

3. Privacy, Market Power, and Future Directions: The article highlights significant concerns about privacy and market power in the context of AI in health care. Legal experts worry that existing laws like HIPAA are inadequate for new AI technologies. There's a fear that AI will be deeply integrated into health care before legislators fully understand its implications. Startups and smaller companies are concerned about potential regulations favoring large corporations like Google, which could stifle competition. Additionally, Google is not only focusing on partnerships with health care companies but also aims to integrate AI into consumer health products, leveraging devices like smartphones and wearables like FitBit.

Are employers overspending on health insurance?

By Bob Gaydos - There’s a major problem in the benefits landscape that has gone unaddressed for far too long. Businesses are spending too much on their health insurance while neglecting other important benefits. Read Full Article…

VBA Article Summary

1. Rethinking Benefits as Investments: The article emphasizes the need for employers to view employee benefits not as an expense but as an investment. This shift in perspective allows for a strategic allocation of benefits budgets, focusing on the returns each benefit can offer. The author argues that health insurance, traditionally a major focus in benefits packages, often yields minimal return in terms of employee satisfaction and retention due to its high costs and low perceived value.

2. Balancing Benefits and Costs: The article suggests that employers should be aware of the total expenditure per employee on benefits and advises a more balanced distribution of these funds. By allocating a significant portion of the benefits budget to more cost-effective options like dental, vision, life, disability, and critical illness insurance, employers can offer a more comprehensive package that better meets employee needs. This approach also involves adjusting health insurance spending to maintain overall affordability while enhancing the benefits package's attractiveness.

3. Introducing Lifestyle Accounts: The author introduces the concept of lifestyle accounts as a novel way to provide high-return benefits. These accounts allow employees the flexibility to choose benefits that best suit their individual needs, potentially leading to greater job satisfaction. Employers contribute a fixed amount to each employee's account, simplifying budget predictions and offering a more personalized benefits experience. This approach also opens up opportunities for employees to explore individual insurance options, enhancing the attractiveness of the company’s benefits package.

Autoimmunity Has Reached Epidemic Levels. We Need Urgent Action to Address It

By Olivia Casey and Frederick W. Miller - At some point in your life, you could have about a one in five chance of developing an autoimmune disease. The odds are greater if you are a woman, you have a genetic predisposition to autoimmunity, or you are exposed to certain pollutants. These diseases include more than 100 lifelong and costly illnesses such as type 1 diabetes, rheumatoid arthritis, lupus and multiple sclerosis. They are often difficult to diagnose and currently impossible to cure. Read Full Article…

VBA Article Summary

1. The Growing Epidemic of Autoimmune Diseases: The article highlights the devastating impact of autoimmune diseases, characterized by the immune system attacking the body. Symptoms like chronic fatigue, pain, depression, and social isolation not only affect mental health but can also lead to early death. There's a lack of effective treatments, and the prevalence of these diseases is increasing worldwide. Research indicates that environmental and lifestyle changes may contribute to this rise. The cost of treating these diseases is also exorbitantly high, with estimates exceeding $168 billion in the U.S.

2. Research and Policy Initiatives: The article emphasizes the need for better research and policy initiatives to combat autoimmune diseases. It discusses the establishment of an Office of Autoimmune Disease Research within the NIH, but suggests the need for a more dedicated institute, similar to the National Cancer Institute. The article also stresses the importance of a unified definition and concept for autoimmune diseases, which currently lack consensus, making research and diagnosis challenging.

3. Strategies for Addressing the Autoimmune Epidemic: The article suggests a multifaceted approach to address the autoimmune disease epidemic. This includes the creation of national reporting systems, similar to cancer registries, to better understand the prevalence and distribution of these diseases. It also calls for an integrated strategy involving various stakeholders - patients, healthcare providers, researchers, and pharmaceutical companies - to coordinate efforts in research, treatment, and prevention. The urgency and importance of acting now to mitigate the growing impact of autoimmune diseases on global health and economies are emphasized.

Law firm wants to challenge health care costs, asks Lockheed Martin workers to join suit

By Alan Goforth - Fairmark Partners is investigating the possibility of filing a class-action lawsuit against aerospace giant Lockheed Martin over its handling of employee benefit contributions. The New York City law firm is soliciting input from current and former employees – some of whom are helping with an investigation – on the TopClassActions website. Read Full Article…

VBA Article Summary

1. Class-Action Lawsuit Investigation Against Lockheed Martin: Fairmark Partners law firm is investigating a potential class-action lawsuit against Lockheed Martin. This investigation is based on concerns that employees and retirees may not have fully understood the costs and implications of their health-care plan when they enrolled. The lawsuit is considering the impact of rising health-care and prescription drug costs, which are significantly increasing employees' expenses and impacting their paychecks. The firm is gathering information from those who feel they didn't fully comprehend their benefits or how their premium payments were utilized by the corporation.

2. Impact of Rising Health-Care Costs on Lockheed Martin Employees: The article highlights the financial burden on Lockheed Martin employees due to escalating health-care costs. The company, like other large corporations, is passing on these increases to its employees, resulting in higher premiums, higher deductibles, and reduced percentages of covered care. The year 2024 is expected to witness the largest jump in health-care costs in decades, further exacerbating the financial strain on employees.

3. Previous Legal Actions Against Lockheed Martin Regarding Employee Benefits: Lockheed Martin has a history of facing legal actions over employee benefits. In 2015, the company settled a lawsuit for $62 million over claims of shortchanging workers and retirees in its pension plans. In 2020, Lockheed Martin settled a disability discrimination lawsuit for $115,000, and in 2022, agreed to make payments into retirement plans and issue checks to former employees. These cases highlight ongoing concerns regarding Lockheed Martin's handling of employee benefits and the legal scrutiny it attracts.

Optum Faces Allegations of Anti-Competitive Practices from CA Health System

By Victoria Bailey - California-based health system Emanate Health has filed a lawsuit alleging that UnitedHealth Group’s Optum violated antitrust laws and engaged in anti-competitive practices regarding physician contracts. Read Full Article…

VBA Article Summary

1. Emanate Health-OPTUM Dispute Overview: Emanate Health, a health system in the San Gabriel Valley, is involved in a legal dispute with Optum, a major healthcare provider and the largest employer of physicians in the U.S. The conflict arose after Optum-Covina, formerly Magan Medical Clinic and acquired by Optum in 2017, experienced a mass departure of physicians who joined Emanate Health Medical Group (EHMG). This led to allegations that Optum transferred patients to other doctors without informing them of their original providers' move to EHMG. Emanate Health accuses Optum of not notifying patients about their providers leaving and scheduling follow-up visits after these departures, preventing providers from informing their patients. Additionally, Optum staff allegedly misled patients about their physicians' whereabouts.

2. Alleged Anti-Competitive Practices by Optum: Emanate Health's lawsuit claims that, beginning around December 2021, Optum engaged in anti-competitive practices to dominate the primary care physician market in areas where Emanate Health patients reside. This includes purported threats to cancel hospital service agreements with Emanate Health hospitals unless Emanate Health complied with new, restrictive terms favoring Optum's market dominance. Optum's proposed terms aimed to make Emanate Health primary care physicians exclusive to Optum for certain health plans and discouraged Emanate Health from recruiting Optum-affiliated physicians. After Emanate Health rejected these terms, Optum allegedly terminated its contracts with Emanate Health hospitals and redirected its members away from Emanate Health facilities, leading to a decline in patient admissions.

3. Emanate Health's Legal Action and Optum's Response: Emanate Health, along with its medical group and independent physician association, has initiated legal action against Optum, citing the need to protect the rights of patients, physicians, and employees. Emanate Health states that efforts to resolve the matter with Optum were unsuccessful and met with retaliation. In response, Optum has dismissed these allegations as baseless, attributing them to a contractual dispute in a competitive market, and has vowed to defend itself vigorously.

Free ChatGPT may incorrectly answer drug questions, study says

By Annika Kim Constantino  - The free version of ChatGPT may provide inaccurate or incomplete responses — or no answer at all — to questions related to medications, which could potentially endanger patients who use OpenAI’s viral chatbot, a new study released Tuesday suggests. Read Full Article…

VBA Article Summary

1. ChatGPT's Limited Accuracy in Drug-Related Information: A study by pharmacists at Long Island University revealed that out of 39 drug-related questions posed to the free version of ChatGPT, only 10 received "satisfactory" responses. The remaining 29 responses were either not directly addressing the question, inaccurate, incomplete, or a combination of these. The study highlighted instances such as incorrect information about drug interactions and dose conversions, demonstrating potential risks in relying on ChatGPT for accurate medical advice.

2. Cautions for Patients and Health-Care Professionals: The study, led by Sara Grossman, an associate professor of pharmacy practice at LIU, advises patients and health-care professionals to exercise caution when using ChatGPT for drug information. It recommends verifying ChatGPT's responses with trusted sources, such as doctors or government-based medication information websites like the NIH’s MedlinePlus. This caution is underscored by the fact that the free version of ChatGPT, used widely by the general public, is limited to data sets through September 2021, potentially lacking in recent medical developments.

3. ChatGPT's Popularity and Concerns: Despite being the fastest-growing consumer internet app following its launch about a year ago, ChatGPT has raised concerns over issues like fraud, intellectual property, discrimination, and misinformation. The Federal Trade Commission even opened an investigation into its accuracy and consumer protections. The study's focus on the free version of ChatGPT, which is more accessible to the general population, provided a snapshot of its performance, indicating that while there may be improvements, reliance on it for critical information like medication should be approached with caution.