Daily Insurance Report - July 6, 2023

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

Discussions of women’s health belong in the workplace: Here’s how to get people talking

By Liz DeForest and Janine Savarese - With the average CEO being around age 56, the women who have ascended to leadership positions in recent years — who hold more economic and regulatory power than ever before — are increasingly more comfortable discussing women’s issues and using their platforms to initiate important conversations on menopause, mental illness and other aspects of their health. Read Full Article…

VBA Article Summary

  1. Increased Comfort in Discussing Women's Health: Women in leadership positions, who hold significant economic and regulatory power, are increasingly comfortable discussing women's health issues such as menopause, mental illness, and overall health. This shift in attitude is fueled by the growing number of women in the workforce and their willingness to initiate important conversations.

  2. Changing Conversations and Breaking Barriers: Women's transparency about their health experiences is transforming workplace conversations and breaking down stigma, research gaps, and other barriers that hinder women from accessing quality care. The increased media coverage of "menopause in the workplace" and the growth of the femtech industry demonstrate the changing landscape around women's health. This shift is projected to have a significant economic impact, with the global menopause market estimated to reach $24.4 billion by 2030.

  3. Company Actions to Support Women's Health: Employers can play a crucial role in supporting women's health by taking specific actions. Promoting transparency within the workplace encourages open dialogue about health issues and helps shatter stigmas. Assessing and improving employee benefits, including mental health resources, hormone therapy coverage, and paid family and medical leave, can remove financial barriers to accessing care. Aligning internal and external communications by reevaluating company culture and demonstrating authentic support for women's health can attract and retain engaged employees and build a more equal society.

AANS, CNS urge CMS to finalize rules to improve prior authorization

By Lily Ramsey, LLM - Today, the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) joined 61 bipartisan senators and 233 members of the House of Representatives in urging the U.S. Department of Health and Human Services and Centers for Medicare & Medicaid Services (CMS) to swiftly finalize rules to increase transparency, streamline and standardize prior authorization (PA), including modifying the final rules to more closely align with the Improving Seniors' Timely Access to Care Act (S. 3018/H.R. 3173). Read Full Article… 

VBA Article Summary

  1. The American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) are urging the U.S. Department of Health and Human Services and Centers for Medicare & Medicaid Services (CMS) to finalize rules that increase transparency and streamline prior authorization (PA).

  2. The senators and representatives support the alignment of the final rules with the Improving Seniors' Timely Access to Care Act, which includes establishing real-time PA decisions, requiring timely responses to urgent care requests, and mandating detailed transparency metrics from Medicare Advantage plans.

  3. The regulations should protect Medicare Advantage patients from unnecessary prior authorization practices and improve their access to medically necessary care. The April 5 final rule by CMS also aims to enhance prior authorization in the Medicare Advantage program.

Will Medicare Pay For Cancer Treatment?

By Barbara Hopkins and Jeanna Smiley - A cancer diagnosis can raise concerns about life, health, and the ability to afford treatments. Fortunately, Medicare can help pay for most qualifying treatments and services, such as doctor’s visits, screenings, and chemotherapy. You may face out-of-pocket costs, depending on your plan. Read Full Article…

VBA Article Summary

  1. Medicare coverage for cancer care: Medicare provides coverage for various aspects of cancer treatment, including inpatient hospital stays for surgery and chemotherapy, skilled nursing facility care, home health care, blood transfusions, and certain costs of clinical research. Part A covers hospital-related services, while Part B covers outpatient chemotherapy, radiation therapy, medical research, and durable medical equipment.

  2. Medicare coverage for cancer prevention and screening: Medicare covers certain preventive health care services and cancer screening tests. Coverage for these services may vary depending on factors such as the location of service, doctor's fees, type of facility, and provider acceptance of assignment. Examples of covered screenings include colonoscopies for colorectal cancer, lung cancer screenings with low-dose computed tomography (LDCT), mammograms for breast cancer, and Pap tests for cervical cancer.

  3. Medicare costs for cancer care: While Medicare covers a significant portion of cancer care expenses, there are still out-of-pocket costs involved. These costs can be influenced by factors such as income, healthcare provider type, treatment location, and annual changes in Medicare out-of-pocket costs. Medicare premiums, deductibles, and copayments are applicable, with specific amounts varying based on the type of Medicare coverage (Parts A, B, C, D) and supplemental plans (e.g., Part G and N). It's important to consult with healthcare providers and ask questions to understand the coverage and potential costs associated with recommended services that Medicare may not cover.

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Retirement Plans = Employee Glue

By John Iekel - Want to keep your employees? Offering a retirement plan could be an answer, says recent analysis. October Three argues that employer-provided retirement plans are a potent tool to retain employees and counters what it calls “the number one problem facing American companies right now. Read Full Article…

VBA Article Summary

  1. Voluntary Resignations and the Need for Retention: In 2021, a record number of employees voluntarily left their employers, with over 47 million individuals resigning. This trend is a significant concern for American companies, with a voluntary resignation rate of 15.9% compared to 11.6% in the previous year. The healthcare sector experienced the highest resignation rate at 19.8%. Millennials and Gen Z employees are also changing jobs at an accelerated pace.

  2. Cost of Employee Turnover: Employee turnover presents a substantial financial burden for employers. In 2021, turnover cost U.S. employers over $700 billion. On average, a single resignation can cost up to 33% of the departing employee's base salary. These costs highlight the need for effective employee retention strategies.

  3. Retirement Plans as a Solution: Offering retirement plans as an employee benefit can serve as a powerful tool to retain talent. Many employees undervalue the importance of retirement benefits, leading to departures. Research shows that more than 40% of resignations in 2021 were influenced, at least in part, by inadequate benefits. Employers should recognize the significance of compensation and benefits in attracting and retaining employees, as 74% of them consider these factors essential. Younger employees, such as Gen Z, are demonstrating an increased awareness of the importance of saving for retirement, with 30% considering it a priority. Employers can leverage this by providing access to retirement plans, as two-thirds of Gen Z employees with such access actively participate in them.

Pharmacy Benefit Management Market Size, Share, Revenue, Trends And Drivers For 2023-2032

By TBRC Business Research Pvt Ltd. - The Business Research Company’s global market reports are now updated with the latest market sizing information for the year 2023 and forecasted to 2032 The Business Research Company’s “Pharmacy Benefit Management Global Market Report 2023” is a comprehensive source of information that covers every facet of the pharmacy benefit management market. Read Full Article…

VBA Article Summary

  1. Market Size and Forecast: The Business Research Company's global market reports have been updated to provide the latest market sizing information for the year 2023 and forecasted data up to 2032. According to their "Pharmacy Benefit Management Global Market Report 2023," the pharmacy benefit management market is predicted to reach a value of $764.8 billion in 2027. The market is expected to grow at a significant annual growth rate of 7.2% throughout the forecast period.

  2. Factors Driving Market Growth: The rise in the number of people availing insurance is a key factor contributing to the growth of the pharmacy benefit management market. As more individuals obtain insurance coverage, the demand for pharmacy benefit management services increases. This trend is expected to continue driving market growth.

  3. Market Segmentation: The pharmacy benefit management market can be segmented based on various factors. The report highlights three key segments:

  • Services: The market is segmented by services, including mail delivery, specialty pharmacy, and preferred network pharmacy. These different services cater to specific needs and preferences of patients and contribute to the overall market growth.

  • Type: The market is segmented by type, including commercial health plans, self-insured employer plans, Medicare Part D plans, and the Federal Employees Health Benefits Program. These segments represent different types of insurance plans that utilize pharmacy benefit management services.

  • End User: The market is segmented by end user, including organizations, mail order pharmacies, retail pharmacies, inpatient pharmacies, and outpatient pharmacies. Each end user segment represents different entities that utilize pharmacy benefit management services to manage prescription costs and streamline the distribution of medicines.

  • Services: The market is segmented by services, including mail delivery, specialty pharmacy, and preferred network pharmacy. These different services cater to specific needs and preferences of patients and contribute to the overall market growth.

Overall, the pharmacy benefit management market plays a crucial role in reducing prescription costs and facilitating effective collaboration between insurance companies, pharmacies, and drug distributors.

Bills would ensure ACA coverage in Michigan

By Rick Pluta | MPRN - Bills to put key provisions of the federal Affordable Care Act into state law are working their way through the Legislature. The bills were adopted on bipartisan votes in the House last week, but were all sponsored by Democrats in the House majority. Read Full Article…

VBA Article Summary

  1. Democratic Representative Matt Koleszar aims to address the uncertainty surrounding health coverage due to ongoing federal court challenges to the Affordable Care Act (ACA). He emphasizes the importance of the federal government's continued provision of healthcare access.

  2. Some Republicans argue that the proposed measures exceed the requirements of the ACA, also known as "Obamacare." However, the House package seeks to ensure minimum coverage requirements, protect individuals with pre-existing conditions and dependents under the age of 26, and prohibit denial of coverage based on gender identity or sexual orientation. It also aims to eliminate lifetime dollar limits on insurance benefits.

  3. If the bills pass and become law, Michigan will become the 15th state to guarantee the availability of ACA coverage, regardless of federal court outcomes. Representative Koleszar acknowledges the history of attempts to overturn the ACA at the Supreme Court level and highlights the need to secure residents' healthcare in the face of potential future challenges. The Senate, with Democratic members already developing their own healthcare legislation, will now review the House bills.

Infographic of the Day

Deloitte: Employers Could Have a Significant Impact on Employees’ Lifespans

By Marissa Plescia - While the average lifespan for Americans is 77.9 years, Americans are living only 65.9 years in good health. A new Deloitte report shows that if changes are made, Americans’ average lifespan could reach 90 years by 2040, with 85 of those years being in good health. Read Full Article…

VBA Article Summary

  1. U.S. life expectancy is at its lowest since 1996 and lags behind other comparable countries. According to a report from Deloitte, the average lifespan for Americans is 77.9 years, but they are living only 65.9 years in good health. This highlights the need for a change in the approach to healthcare and wellness.

  2. Employers have a major role to play in creating this change. Deloitte's report suggests that if employers and the healthcare industry adopt a future-focused vision, which includes prioritizing wellness and prevention, leveraging technology like wearable devices, educating healthcare consumers, and personalizing care, Americans' average lifespan could reach 90 years by 2040, with 85 of those years being in good health.

  3. Employers can support this change by shifting their focus to preventive and personalized care. This may involve improving access to health screenings, mental health support, and healthy lifestyle options. Providing educational materials on health, leveraging wearable devices and digital tools, and investing in social determinants of health like affordable housing and clean air and water are also important steps. While there may be initial financial investments, the long-term benefits include healthier employees, reduced healthcare costs, and potentially longer retention of skilled workers. However, the responsibility for change doesn't solely rest with employers; the healthcare industry as a whole needs to promote alternative sites of care, tap into technology and AI, and prioritize prevention over reactive care.

Employees want weight loss drugs Ozempic and Wegovy. Can employers afford them?

By Stephanie Schumer - A wave of interest in trending weight loss drugs, fueled by headline-dominating celebrity slim-downs, is causing some employers to see their healthcare costs skyrocket. Now, leaders are turning to benefit providers, advisers and innovators to help them quell costs and offer alternative solutions to treat obesity and manage weight. Read Full Article… 

VBA Article Summary

  1. GLP-1 medications, such as Ozempic, Wegovy, and Mounjaro, are effective for treating diabetes and promoting weight loss, with some individuals achieving a weight loss of 15% or more of their body weight. These drugs are comparable to the results of bariatric surgery, making them valuable for those in need of medical intervention.

  2. The rising popularity of GLP-1 medications has led to increased costs for employers providing healthcare benefits. Employers are concerned about the long-term expenses associated with these medications, as they need to be taken continuously, and research shows that weight gain is likely if the medication is stopped. With approximately 40% of American adults being obese, the costs related to obesity are already significant, and the use of GLP-1 medications may further increase these expenses.

  3. Employers are seeking ways to provide appropriate care while managing the costs associated with GLP-1 medications. They recognize the potential life-changing benefits of these drugs in preventing conditions like diabetes and musculoskeletal issues, but they also understand the need for clinical appropriateness and cost control. Employers are exploring solutions such as weight management platforms, coaching, clinical care, and technology-based interventions to support their employees' weight management journey while keeping costs manageable.

Maine Legislature takes first step toward adopting paid family leave program

By Joe Lawlor - The Maine Senate voted 22-12 along party lines Wednesday to create a statewide paid family and medical leave program. Gov. Janet Mills is still deciding whether to support the measure. If passed by the House and signed into law by the governor, the program would place a new tax on most employers and employees to pay for a program that compensates workers for as much as 12 weeks of leave from their jobs. Read Full Article…

VBA Article Summary

  1. Workers could qualify for paid leave for various reasons: The proposed bill aims to provide paid leave to workers in Maine for reasons such as taking care of newborns, elderly family members, and their own illness, among others.

  2. Compromises made to address business concerns: The governor's administration has incorporated changes into the bill to make it more business-friendly, including reducing benefit payouts and implementing stricter eligibility requirements.

  3. Political divisions and potential referendum: The Senate vote on the bill followed party lines, with Democrats supporting it and Republicans opposing it. The bill lacks enough support to override a potential veto by the governor. If the bill fails, there is a possibility of a future referendum on the issue, supported by advocacy groups that have collected thousands of signatures.