Daily Insurance Report - July 5, 2023

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

What Do Payers Need to Help Value-Based Contracting Deals for Novel Therapies Succeed?

By Stephanie Baum - A panel discussion at the annual Abarca Forward conference in Puerto Rico last month sought to identify some of the innovative financial approaches that can be applied to managing the high price of novel therapies. Conversations also addressed what payers need for these financing models to be sustainable. Read Full Article…

VBA Article Summary

  1. The current landscape: There are currently 2,053 gene therapies and genetically modified cell therapies in development, and it is predicted that spending for these therapies will reach $30 billion by 2026. However, the high cost of these therapies poses a challenge to their accessibility and affordability.

  2. Value-based pricing arrangements: The panel discussion at the Abarca Forward conference emphasized the importance of value-based pricing arrangements to align incentives among payers, pharmaceutical companies, providers, and patients. Such arrangements can ensure that the pricing of therapies reflects their real-world benefits and outcomes.

  3. Alternative financing models: Various alternative financing models are being explored to address the high costs of cell and gene therapies. These include the recommendation for a new national Medicaid drug benefit, stop-loss provisions for self-insured employers, reinsurance partnerships between pharmaceutical companies and insurers, and the development of innovative financing and reimbursement models through initiatives like the NEWDIGS Think Tank and the FocUS Project.

Washington’s long-term care payroll tax starts July 1, as other states explore similar programs

By Ed Komenda - Since he was a teen, the 41-year-old Seattle resident has often struggled with lupus, an autoimmune disease that can cause the body to attack tissue surrounding joints and organs, making everyday tasks like showering, cooking and commuting to his golf course restaurant job impossible. Read Full Article… 

VBA Article Summary

  1. Washington State's new program, WA Cares, aims to provide long-term care benefits for residents who cannot live independently due to illness, injury, or aging-related conditions. It deducts money from workers' paychecks to finance these benefits, addressing the growing need for long-term care as the elderly population increases.

  2. Private long-term care insurance is costly and often requires passing a health screening, leaving many individuals without coverage. Medicare only covers limited care for skilled nursing or rehabilitation, while Medicaid requires low-income status and spending down savings to qualify. WA Cares offers a social insurance solution by deducting a small percentage from workers' paychecks throughout their careers.

  3. The program starts in July, deducting 0.58% of total pay per paycheck. The funds will be available from 2026 for those who qualify, covering services like in-home care, home modifications, transportation, and reimbursement for family caregivers. The maximum lifetime benefit is $36,500, with annual increases based on inflation. However, some opponents argue that this benefit is insufficient to cover the high costs of long-term care, which can reach thousands of dollars per month.

For remote workers, time to get out of the house

By Isabella Aldrete - While most employees say that remote work has helped their mental health, many challenges remain that employers need to keep an eye out for. About a third of employees say they struggle to leave the house enough when working remotely, according to a recent survey from Flexjobs, while another third report feeling overworked. Read Full Article…

VBA Article Summary

  1. Remote work has positive effects on employees' mental health, but challenges related to work-life balance and disengagement still exist. A significant number of employees struggle to leave the house enough and feel overworked while working remotely.

  2. To address these challenges, employers should encourage the establishment of designated workspaces and break times, creating clear boundaries between work and personal life. They should also ensure that employees take sufficient time off and actively support their mental health.

  3. Remote work can lead to feelings of isolation and reduced collaboration. Employers can mitigate this by scheduling dedicated work and non-work engagement time, organizing joint problem-solving sessions, and using communication platforms like Slack to foster connection and engagement. Additionally, platforms like Sococo or Walkabout Workplace can simulate a physical office space experience. Employers should actively promote active engagement in the digital workplace to support employees' career advancement and skill development.

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10 hospitals with highest, lowest rate of unplanned readmissions

By Mackenzie Bean - Becker's has compiled a list of hospitals with the highest and lowest 30-day readmission rates using data from CMS' Care Compare website. The agency's 30-day unplanned hospitalwide readmission measure is an estimate of unplanned readmission to any acute care hospital within 30 days of discharge from a hospitalization for any cause. Read Full Article…

VBA Article Summary

  1. The agency has a measure that estimates the rate of unplanned hospital readmissions within 30 days of discharge. This measure includes various types of admissions and applies to all acute care hospitals. The data released on April 26 covers admissions from July 2020 to June 2021, excluding the first and second quarters of 2020 due to the impact of the COVID-19 pandemic. The national rate of readmission after discharge was found to be 15 percent.

  2. Lowest Readmission Rates:

    • Hospital For Special Surgery (New York City) — 9.9 percent

    • Kootenai Health (Coeur D'alene, Idaho) — 11.8 percent

    • O.A.S.I.S. Hospital (Phoenix) — 11.9 percent

    • Kansas Surgery & Recovery Center (Wichita) — 11.9 percent

    • W.G. (Bill) Hefner Salisbury (N.C.) VA Medical Center — 11.9 percent

    • Mayo Clinic Health System-Franciscan Medical Center (La Crosse, Wis.) — 11.9 percent

    • New England Baptist Hospital (Boston) — 12.1 percent

    • Lancaster (Pa.) General Hospital — 12.1 percent

    • OrthoIndy Hospital (Indianapolis) — 12.2 percent

    • McBride Orthopedic Hospital (Oklahoma City) — 12.4 percent

  3. Highest Readmission Rates:

    • Pittsburgh VA Medical Center-University Drive — 22.5 percent

    • Oroville (Calif.) Hospital — 21 percent

    • Syracuse (N.Y.) VA Medical Center — 20.9 percent

    • Bay Pines (Fla.) VA Medical Center — 20.8 percent

    • VA Boston Healthcare System-Jamaica Plain — 20.5 percent

    • VA Long Beach (Calif.) Healthcare System — 19.9 percent

    • Atlanta VA Medical Center (Decatur) — 19.9 percent

    • Providence (R.I.) VA Medical Center — 19.2 percent

    • Dallas VA Medical Center — 19.2 percent

Millennial Money: You're not too young to make a will

By Dalia Ramirez - Making a will isn't a task just for the old and wealthy. It's also for the well-prepared. Recent years serve as a heavy reminder that you might not know when your last days are. Life expectancy in the U.S. dropped in both 2020 and 2021, driven by COVID-19 deaths and an increase in accidental deaths, according to the most recent data available from the Centers for Disease Control and Prevention. Read Full Article…

VBA Article Summary

  1. Importance of having a will:

    • Without a will, assets are distributed by a probate court according to the state's laws of intestacy, which can be a longer and more complicated process.

    • Dying intestate can result in assets going to unintended recipients, causing potential financial complications.

    • Having a will is essential for naming a legal guardian for your children and ensuring they inherit according to your wishes.

  2. When to make a will:

    • Life events, rather than age, should determine when to make a will.

    • Events such as acquiring assets, getting married, having a child, or facing health issues should prompt the creation of a will.

    • Making a will as soon as one reaches legal age (typically 18) can offer protection and security for personal assets.

  3. Getting started with making a will:

    • Making a will doesn’t have to be expensive or time-consuming.

    • Free will templates and online will-making software can be used, ensuring compliance with state requirements.

    • Those with complex assets or family situations may benefit from consulting an estate planning attorney, although it may involve additional costs.

    • Trusts can be considered for faster and more seamless asset transfer, especially for volatile assets or when minor children are involved, but having a will is still valuable and preferable to having no plan at all.

America’s oldest and best disability benefit system

By Will Raderman - As Americans prepare to celebrate the declaration of our nation’s independence, we should commemorate the disability benefits established in response. Although the Social Security Act of 1935 established the first substantive federal benefits available to the general public, there is an extensive history of U.S. policymakers approving monetary support for war veterans who suffered injuries during their service, starting with the American Revolution. Read Full Article…

VBA Article Summary

  1. Distinctive structure: Veterans' disability benefits have a unique and straightforward structure compared to civilian disability benefit programs. Veterans receive disability ratings on a scale of 0 to 100, determining the size of their benefits. This system ensures that even veterans with partial disabilities receive support proportional to the impact of their impairments, unlike the all-or-nothing approach of civilian programs.

  2. Financial limitations: Unlike civilian disability programs, veterans' benefits do not impose financial restrictions on beneficiaries. Disabled veterans can pursue post-service financial opportunities without the fear of losing their benefits. In contrast, programs like SSI and SSDI have financial criteria that inhibit work and savings, creating precarious situations for beneficiaries.

  3. Historical development: Veterans' disability benefits have undergone significant development over the past century and a half, while civilian disability benefits have faced political hurdles. The establishment of large-scale veterans' benefits came with growing pains, but they eventually became the gold standard for disability programs. Meanwhile, civilian disability benefits lagged behind, with weaker coverage and delayed support for non-service-related injuries.

Spike in teen depression aligns with rise of social media, new poll suggests: ‘It’s not going anywhere’

By Melissa Rudy - "I can’t do anything right." "I do not enjoy life." "My life is not useful." The share of teens who agree with these phrases has doubled over the past decade, according to an annual poll conducted by the University of Michigan — and one expert asserts that the increase in depressive symptoms is tied to the rise of social media. Read Full Article… 

VBA Article Summary

  1. Increase in Teen Depression Linked to Social Media Use:

    • Dr. Jean Twenge's book highlights the correlation between the spike in teen depression and the rise in social media use.

    • University of Michigan's poll shows a significant increase in the number of students expressing agreement with negative sentiments related to their enjoyment of life.

    • Psychological consultants and experts agree that frequent and prolonged social media use is associated with elevated risk for psychological distress, such as depression and anxiety, particularly among children and adolescents.

  2. Social Media's Impact on Mental Health and Relationships:

    • Experts suggest that social media poses mental health risks, contributing to psychological distress among young people.

    • Excessive social media use limits real-life, person-to-person relationships and promotes feelings of comparison and despair.

    • Social media's addictive nature, lack of self-regulation among children and teens, and the vulnerability of their developing brains further exacerbate the negative effects on mental health.

  3. Addressing the Issue and Setting Limitations:

    • While completely eliminating social media is unrealistic, experts recommend setting limitations for children and teens.

    • Promoting factors that prevent depression, such as close relationships, outdoor activities, physical exercise, proper nutrition, positive social interactions, and quality sleep routines, is crucial.

    • Parents and society should have larger discussions and expectations regarding reasonable social media use, along with enforcing guidelines and providing support to help teenagers navigate these challenges.

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The harm of COVID restrictions

By Tribune News Service - Ronald Reagan famously said, “The nine most terrifying words in the English language are: I’m from the government, and I’m here to help.” What an apt summation of the government’s heavy-handed efforts to fight the coronavirus. Read Full Article…

VBA Article Summary

  1. The effectiveness of pandemic lockdowns: The Institute of Economic Affairs published a book analyzing the impact of pandemic lockdowns, with contributions from prominent professors. The authors' meta-analysis suggests that the lockdowns implemented in the spring of 2020 had a negligible effect on COVID-19 mortality. Instead, they highlight the role of voluntary behavioral changes, such as social distancing, in mitigating the pandemic.

  2. Balancing competing priorities: While lockdowns may have averted approximately 16,000 deaths during the spring of 2020 in the United States, it is important to consider the broader context. Comparatively, an average of 38,000 people die from the flu annually in the country, yet lockdowns have never been proposed to prevent flu deaths. Elected representatives must weigh the trade-offs between preventing COVID-19 or flu deaths and the negative public health issues that arise from lockdowns, such as increased drug overdoses, suicides, and homicides.

  3. Unintended consequences of lockdowns: The article highlights the adverse effects of lockdowns on various aspects of society. For instance, drug overdose deaths increased significantly during the pandemic, with a rise from fewer than 71,000 in 2019 to over 91,000 in 2020, and further to 109,000 in the following year. Suicide and homicide rates also saw an increase since 2019. Additionally, school closures and online learning disruptions led to significant learning losses, particularly impacting the lowest-performing students. These unintended consequences demonstrate the need to consider multiple variables when evaluating the merits of proposed policies beyond a single focus.