Daily Insurance Report - July, 11 2023

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

Benefits Administration Software Market Size, Outlook and Forecast to 2030 with Top Regions Data

By Market Reports World - Benefits Administration Software Market Latest Research Report analyses the growth opportunities and trends in the markets development till 2030. The Benefits Administration Softwares market offers a thorough analysis of the market's drivers and restraints using both qualitative and quantitative methods. This research provides a thorough overview of the market landscape, empowering companies with the knowledge they need to decide on their company strategies and prospective growth. Read Full Article…

VBA Article Summary

  1. Detailed Analysis of Business: The research report provides a detailed analysis of the Benefits Administration Software market, covering various aspects such as applications (small business, medium-sized business, large business) and types (on-premise, cloud-based). It offers conclusive information about the industry, making it easily accessible for readers and users.

  2. Top Manufacturers: The report lists the top manufacturers in the Benefits Administration Software market, including Paycor, Workday, Oracle, PlanSource, Paylocity, Benefitfocus, Thomsons Online Benefits, Gusto, Paychex Flex, Empyrean Benefit Solutions, Inc., Ceridian, ADP, Castlight Health, Ultimate Software, and Businessolver.

  3. Market Insights: The report provides comprehensive insights into the Benefits Administration Software market, covering market overview, segmentations, trends, opportunities, challenges, competitive analysis, company profiles, and trade statistics. It also includes statistical information presented in a simplified format, enhancing the visual representation and decision-making capabilities for business strategy.

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Biden Administration Takes Action Against Junk Insurance, Surprise Bills

By Marissa Plescia - The Biden Administration is proposing that short-term health plans are limited to three months, or a maximum of four months if they’re extended. It comes after the Trump Administration allowed members to stay on the plans for 12 months and renew them for three years. The plans are often limited in coverage and leave consumers with high medical costs. Read Full Article… 

VBA Article Summary

  1. Junk insurance: Short-term health plans, often referred to as "junk insurance," lack essential coverage such as mental health and prescription drugs, and do not provide consumer protections for pre-existing conditions.

  2. Proposed rules by the Biden Administration: The Biden Administration is proposing that short-term health plans be limited to three months, with a maximum extension of four months. The plans will also be required to provide a clear disclaimer explaining the limitations of their benefits to both new and existing consumers.

  3. Support for the proposed rule: A group of 37 organizations, including the American Heart Association and the National Health Council, have issued a joint statement applauding the Biden Administration for the proposed rule. These organizations argue that short-term health plans leave patients vulnerable to high medical bills and should only serve as a temporary backstop between health insurers.

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Extending Medicare APM incentives is key to value-based care’s future

By Kevin B. O’Reilly - As part of its campaign to fix the unsustainable Medicare physician payment system, the AMA is outlining in a quick, easily navigable fashion the policy changes needed to realize the robust physician pathway to alternative payment models (APMs) that Congress envisioned. Read Full Article…

VBA Article Summary

  1. Limited physician participation in Medicare APMs: The AMA's explainer highlights that there are fewer opportunities for physicians to participate in Medicare Alternative Payment Models (APMs) than initially anticipated under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. The models implemented so far have strict financial risk requirements, insufficient funding for care delivery redesign, and limited availability in selected regions.

  2. Reauthorization and flexibility of incentive payments: The AMA calls for the reauthorization of the crucial 5% incentive payments that encourage physician participation in Advanced APMs. These payments should be extended beyond 2023 and should have more flexible and realistic revenue thresholds to qualify for earning the incentives. Increasing the revenue threshold from 50% to 75% would impede the movement towards APMs, as data shows that the average revenue generated by participants in the largest APM is 63%.

  3. Criteria update for adopting and expanding APMs: The criteria for achieving Medicare savings need to be revised to prevent the termination of payment models and limited adoption among specialty physicians. The AMA emphasizes the need for meaningful pathways for stakeholder-developed APM proposals, particularly those endorsed by the Physician-focused Payment Model Advisory Committee, to be implemented in Medicare. Upgrading and expanding Medicare APMs would lead to improved patient outcomes and reduced unnecessary Medicare spending.

AMGA Leaders Connect Medical Staffing Issues and Consumer-Responsiveness Issues

By Mark Hagland - Leaders at AMGA Consulting, a division of the American Medical Group Association, see consumer responsiveness as an absolute priority for medical groups to overcome staffing issues. As Healthcare Innovation reported at the end of May, “Staffing shortages and staffing costs continue to dog the administrators of medical clinics nationwide, according to the just-published results of a nationwide survey conducted by the Alexandria, Va.-based AMGA (American Medical Group Association).” Read Full Article… 

VBA Article Summary

  1. Staffing shortages and costs remain a challenge for medical clinics nationwide. According to a survey conducted by the American Medical Group Association (AMGA), medical groups and health systems reported a median 10% increase in staffing costs from 2022 to 2023. Despite some improvement, clinic staffing levels, particularly for clinical support roles like RN/LPN/MA, continue to be in a downward trajectory.

  2. Medical groups are addressing clinic staffing shortages through various strategies. The survey revealed that incentives, process improvements, and care model/staffing structure changes are being utilized to tackle staffing challenges. Medical groups are offering referral bonuses, sign-on bonuses, and making changes to benefits packages to support recruitment and retention. They are also focusing on process changes with a technology focus, such as automation at the front end of the visit process, online patient portals, and self-check-in/kiosks for office visits.

  3. Recovery and stabilization are observed in clinic staffing, but challenges persist. While overall clinic staffing appears to be stabilizing and returning to pre-pandemic levels, there are variations across different regions and types of physician organizations. The survey highlights concerns about the shortage and burnout of clinical providers, including physicians and advanced-practice providers. Medical assistant roles are also a specific area of concern, as organizations have had to replace them with higher-paid professionals like LPNs or RNs. The integration of technology and an emphasis on consumer-facing technologies are seen as key strategies to address staffing issues and enhance efficiency in clinics and practices.

Google’s medical AI chatbot is already being tested in hospitals

By Wes Davis - Google’s Med-PaLM 2, an AI tool designed to answer questions about medical information, has been in testing at the Mayo Clinic research hospital, among others, since April, The Wall Street Journal reported this morning. Med-PaLM 2 is a variant of PaLM 2, which was announced at Google I/O in May this year. PaLM 2 is the language model underpinning Google’s Bard. Read Full Article…

VBA Article Summary

  1. Google's Med-PaLM 2 Model: Google has developed the Med-PaLM 2 model, which is an updated version trained on a curated set of medical expert demonstrations. The company believes that this model will outperform generalized chatbots like Bard, Bing, and ChatGPT in healthcare conversations, especially in countries with limited access to doctors.

  2. Accuracy Issues of Med-PaLM 2: Despite its potential, Med-PaLM 2 still exhibits accuracy issues commonly seen in large language models. A research paper released by Google in May revealed that physicians found more inaccuracies and irrelevant information in the answers provided by Med-PaLM and Med-PaLM 2 compared to responses from other doctors.

  3. Data Privacy and Early Stages of Development: Customers testing Med-PaLM 2 will have control over their data, which will be encrypted and inaccessible to Google. Google senior research director Greg Corrado mentioned that Med-PaLM 2 is still in its early stages, and while he wouldn't personally rely on it for his family's healthcare, he believes it significantly expands the areas where AI can be beneficial in healthcare.

Prepare for a power shift: Why employers' return-to-office plans may backfire

By Lee Hafner - As the labor market continues to dance, employers may currently feel like they have the upper hand over employees and job seekers. But wise leaders should use this time to make sure workers won't abandon their organization at the first sign of an economic power shift. With employee engagement numbers low — only 32% are engaged at work, according to Zippia — and a continued focus on better work-life balance, employers will be hard-pressed to hang on to their talent if they don't put people first. Read Full Article… 

VBA Article Summary

  1. Employee engagement and work-life balance are crucial for retaining talent: With only 32% of employees engaged at work, employers need to prioritize putting people first to hold onto their talent. The focus should shift from viewing the job market as employer-friendly or employee-friendly to fostering a mutually beneficial relationship.

  2. Flexibility is a key employee benefit: Many employees are dissatisfied with the demand to return to the office, which compromises their flexibility and work-life balance. A survey shows that 70% of employees expect flexibility, and one-third consider it the most important employee benefit. However, only 5% of corporate executives plan to expand hybrid work policies. Getting dynamic or hybrid work right is essential for companies to survive and thrive.

  3. Building trust and meeting employee needs: To create a positive work environment and avoid resentment from employees, employers should focus on building trust and offering what employees truly want. KJ Johnson suggests four ways to keep teams engaged: actively listening to employees, having open-minded leadership that recognizes the changed workplace, customizing company schedules based on individual functions, and linking plans back to company values. By implementing these strategies, companies can retain talent and strengthen their organizational culture.

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Despite Preferences for In-Person Care, Patients Are Open to Telehealth

By Mark Melchionna - An EY Global Consumer Health Survey of 2023 provided insight into the overarching preference that patients have for in-person care but also noted relatively high levels of willingness to use virtual primary care and telehealth for certain consultations. The survey polled 6,021 people aged 18 and over across the United States, Canada, Australia, Germany, England, and Ireland, between Jan. 12 and March 10. The US survey included responses from 1,000 healthcare consumers. Read Full Article… 

VBA Article Summary

  1. Patient preference for in-person care: A survey conducted in the US revealed that a significant portion of the population (80%) still prefers in-person care over telehealth for addressing physical issues. The preference for in-person care is driven by factors such as the belief that it establishes better personal connections (72%), perceived higher care quality (67%), and improved issue resolution (64%).

  2. Openness to virtual primary care: Despite the preference for in-person care, the survey also indicated that a considerable number of patients are open to participating in virtual primary care. Only 10% of respondents said they would not consider switching to virtual primary care. Around 45% of patients expressed willingness to participate, while an additional 32% stated potential consideration. The main reasons cited for openness to telehealth were convenience, assistance with lower urgency issues, and ease of paperwork completion.

  3. Patient awareness of and preparedness for technology-based care: The survey revealed that many healthcare consumers are prepared to leverage technology-based care to personalize their healthcare experiences. Respondents expressed openness to genetic testing (66%), receiving non-urgent care at mini-clinics in department stores or supermarkets (66%), personalized medications (64%), and the use of wearables and sensors to collect health data (61%). Additionally, a majority of respondents believed that artificial intelligence, virtual presence, digital technologies, hospital-at-home programs, and precision medicine will continue to grow in the healthcare industry in the next ten years.

Overall, while telehealth faces challenges in gaining trust and acceptance from certain patients, there is a significant level of openness and willingness among patients to engage with virtual primary care and technology-based healthcare solutions.

Hospitals will recoup $9B under HHS' proposed remedy to 340B ruling

By Heather Landi - The federal government will pay eligible hospitals in the 340B program $9 billion to offset payment cuts the Supreme Court ruled unlawful last year. In 2018, the Department of Health and Human Services (HHS) cut prescription drug payments for 340B-covered entity hospitals by nearly 30%. The American Hospital Association (AHA) and other hospital groups sued to halt the cuts, and an appellate court sided with HHS that it has the power to make the cuts. Read Full Article…

VBA Article Summary

  1. The Supreme Court's ruling in June 2022 rejected the payment cuts to hospitals under the 340B drug discount program, deeming them unlawful. The court found that the payment rates for 340B-acquired drugs were illegal because the Department of Health and Human Services (HHS) did not follow the proper procedure, failing to conduct a survey of hospitals' acquisition costs.

  2. The Centers for Medicare & Medicaid Services (CMS) proposed a rule to address the remedy for the payment policy. The proposed rule includes a one-time lump-sum payment to approximately 1,600 340B-covered entity hospitals that were underpaid due to the invalidated policy. CMS estimates that affected providers received $10.5 billion less in payments and plans to disperse the lump-sum payment by the end of 2023 or early 2024.

  3. While hospitals welcomed the lump-sum payment, HHS also proposed recouping funds from hospitals that received increased rates for non-drug services from 2018 to 2022. CMS estimates that hospitals were overpaid $7.8 billion for non-drug items and services during this period. The agency plans to recoup these funds by reducing hospital payments for other non-drug items and services by 0.5% for the next 16 years. Providers expressed concerns about the budget neutrality aspect of the proposed rule and the lack of interest on the remedy payments.