For providers, consolidation may be key to staying afloat, experts tell senators

By Frank Diamond - Consolidation has been the norm across healthcare for some time, and for those in the industry that want to stay independent, watching their peers unite can be intimidating. Chris Thomas is the president and CEO of Community Hospital, an independent hospital located in Grand Junction, Colorado. He told a key Senate panel on Thursday that large systems have plenty of leverage against smaller, independent players. Read Full Article…

VBA Article Summary

1. Consolidation in the healthcare industry: The healthcare industry has seen a significant trend towards consolidation, with larger health systems acquiring smaller, independent entities such as hospitals and insurance providers. This poses a threat to those who wish to remain independent, like Chris Thomas, president and CEO of Community Hospital in Colorado, who has expressed concerns that larger systems will dominate the market, potentially blocking access to smaller hospitals. This was a key topic at a recent Senate Finance Committee hearing, with discussions also covering insurer consolidation, pharmacy benefit managers and the role of private equity in healthcare.

2. Impact of consolidation on hospitals and healthcare practitioners: The consolidation trend impacts both hospitals and healthcare practitioners. As per Zack Cooper, an associate professor of economics at Yale University, about 1,000 hospital mergers have occurred in the U.S. in the last two decades. He cited a lack of site-neutral billing in Medicare and the 340B drug pricing program as contributing factors. Additionally, R. Shawn Martin, CEO of the American Academy of Family Physicians, noted that 73% of the approximately 129,000 physicians in the AAFP are employed by a hospital system, health insurer, or other corporate entity. This shift is driven by factors like inadequate payments for physicians, lack of investment in primary care, and growth in public programs.

3. Divergent views on the implications of consolidation: While some argue that consolidation can lead to better patient care and help struggling hospitals survive (as posited by the American Hospital Association), others raise concerns about its impact on affordability. David Merritt, senior vice president of policy and advocacy for the Blue Cross Blue Shield Association, argued that hospital acquisitions of independent physician practices lead to an average price increase of 14%. This makes healthcare less affordable as these higher costs are ultimately borne by patients through increased premiums.

Health systems' top 10 AI priorities for the next 2 years

By Giles Bruce - Hospitals and health systems are already using artificial intelligence to varying degrees, but they have big plans to adopt the technology in the near future, a new report from the Center for Connected Medicine at Pittsburgh-based UPMC and KLAS Research found. Read Full Article…

VBA Article Summary

1. AI Investment in Healthcare: A new report from the Center for Connected Medicine at Pittsburgh-based UPMC and KLAS Research found that hospitals and health systems have big plans to invest in artificial intelligence (AI) over the next two years. The report is based on a survey of 49 providers and payers.

2. Top Areas for AI Application: The top three areas where healthcare organizations plan to invest in AI are operational optimization (with 30 organizations planning to invest), health/disease management and prediction (29 organizations), and population health management (25 organizations).

3. Other Areas of Interest and Non-interest: Other areas of interest for AI application include value-based care (24 organizations), patient/member engagement (20 organizations), clinical research (17 organizations), and imaging (16 organizations). Meanwhile, 6 organizations were unsure of their AI investment plans, 4 had no plans to invest in AI, and 1 had other plans that include drug diversionHow Employee Benefits Will Shift in the Next 3 Years

Postpartum depression is on the rise, and new moms aren’t getting the treatment they need

By Alyssa Place Becoming a new parent can be both a joyful and challenging experience, yet for those struggling with postpartum depression, those early days can be especially dark.

The National Institute of Health estimates between 6-20% of women will struggle with postpartum depression. While emotional changes are expected after giving birth, postpartum depression has longer-lasting effects that could impact one's ability to care for a child or handle daily tasks. Symptoms like extreme mood swings, crying, anger and hopelessness are common, according to the Mayo Clinic. Read Full Article…

VBA Article Summary

1. Prevalence and Impact of Postpartum Depression: Postpartum depression is a mental health disorder affecting between 6-20% of women after childbirth, according to the National Institute of Health. The disorder is characterized by symptoms such as extreme mood swings, crying, anger, and hopelessness. When untreated, it can have severe, long-term effects on not only the mother's health but also the well-being of the entire family. Unfortunately, receiving adequate treatment proved more difficult during the COVID-19 pandemic, with 46.5% of women with postpartum depression reportedly not receiving any treatment.

2. Challenges and Changes in Healthcare due to the Pandemic: The pandemic introduced a host of challenges for pregnant women and new mothers, with many being unable to attend appointments or give birth with their partners present. These circumstances, coupled with social isolation and increased rates of domestic violence, were detrimental to women's mental health. However, the adaptation of the healthcare system during the pandemic to incorporate virtual care could benefit women seeking care, allowing easier access to primary care physicians or therapists from home.

3. Role of Employers in Supporting New Mothers: Employers have a significant role in supporting new mothers through their benefits programs and workplace accommodations. Policies such as full-spectrum postpartum care coverage, including mental health care, flexible schedules, work arrangements, lactation rooms, and paid parental leave can greatly assist new mothers. It is also vital for employers to provide benefits that cover case management programs to ensure quick diagnoses and impactful support for women suffering from postpartum depression. This includes the promotion of collaboration with case managers who are specifically trained to screen for mental health issues and provide rapid and effective care.

US Chamber of Commerce sues over government's drug pricing power

By Jonathan Stempel - The U.S. Chamber of Commerce on Friday sued the federal government, challenging a new law that for the first time gives Medicare the power to negotiate drug prices with pharmaceutical companies. Read Full Article…

VBA Article Summary

Lawsuit Against New Medicare Drug Pricing Program: The U.S. Chamber of Commerce has filed a lawsuit against the federal government, challenging a new law that grants Medicare the power to negotiate drug prices with pharmaceutical companies. The lawsuit contends that the pricing program gives the government unlimited discretion to set maximum prices and violates drugmakers' due process rights as provided by the U.S. Constitution.

1. Arguments Against the Pricing Program: The U.S. Chamber of Commerce argues that the new pricing program could potentially impose severe penalties on pharmaceutical companies that don't adhere to the set prices, effectively giving them an ultimatum to agree to government-dictated prices or risk business disruption. They also warn that these price controls may deter pharmaceutical companies from developing new drugs, causing long-term harm to American citizens and their health.

2. Government's Defense and Potential Savings: The U.S. Department of Health and Human Services, which administers Medicare through its Centers for Medicare & Medicaid Services, plans to strongly defend the program, asserting that it is already helping to lower healthcare costs for older adults and people with disabilities. The Biden administration hopes that this initiative will save approximately $25 billion annually by 2031 by allowing Medicare to negotiate prices. Despite the ongoing lawsuits, the White House maintains confidence in its position, stating that nothing in the Constitution prevents Medicare from negotiating lower drug prices.

Better Predicting Drug Safety Calms Quarrels Between Medical Needs & Regulatory Process

By Isaac Bentwich - Human tissues, coupled with AI that can deal with terabytes of data will blow mice models out of the water. With animal testing requirements finally removed, the pharma industry and its constituents can hope for faster innovation. Read Full Article…

VBA Article Summary

1. FDA Modernization Act 2.0: The enactment of the FDA Modernization Act 2.0 is a significant development in the pharmaceutical industry. The legislation puts an end to the requirement for animal testing on drugs under development, a mandate that had been in place for over 80 years. The introduction of non-animal drug testing methods, such as artificial intelligence (AI) and organs-on-a-chip, will accelerate the drug discovery process, potentially reducing costs and time taken to bring new drugs to market.

2. Increased Efficacy in Drug Testing with AI: AI combined with human tissues offers a superior method for predicting drug safety compared to traditional mice models. This innovation allows for faster pharmaceutical advancements and could substantially increase the success rate of new drugs, reducing research costs and ultimately the price of drugs. Using AI in drug testing will not eliminate the need for physical trials but will streamline the process, reducing the pool of drug candidates for testing.

3. Reconsideration of Approval Processes and Patent Lengths: The current drug approval processes, which can span multiple years, are being reassessed. Certain life-saving drugs may need to be fast-tracked to address patient needs promptly. Moreover, there is a call to extend the length of patents to allow pharmaceutical companies sufficient time to recover their investment costs. This could lead to a decrease in the price of drugs as companies would have an extended period of exclusive sales. The future of the industry looks to AI as the path forward, aiming to increase efficiency, reduce costs, and better tailor drugs to individual patient needs.

4 Steps for Large Employers to Meet Fiduciary Duties and Mitigate Legal Risk

By Darren Fogarty Associate Director, Purchaser Value - The Consolidated Appropriations Act (CAA) has created both opportunities and risks for employers when it comes to overseeing employee health benefits. The CAA finally gives employers access to the kinds of cost-benefit data long available with virtually every other business decision. The law equips them to better perform their role as stewards of company and employee finances by assessing the value of the health care services they purchase for employees. Read Full Article…

VBA Article Summary

1. New Opportunities and Risks with the CAA: The Consolidated Appropriations Act (CAA) provides employers with access to cost-benefit data concerning employee health benefits, previously available for other business decisions. However, this data access also introduces new fiduciary responsibilities. The CAA stipulates that employers need to establish processes to assess the value of healthcare services purchased for their employees. However, the compliance to these new rules among vendors has been inconsistent.

2. Employer Responsibilities Under the CAA: Employers have to develop robust fiduciary processes related to healthcare purchasing, which involves good-faith efforts to comply with the CAA. This compliance could lead to a safe harbor reducing future legal exposure and compliance issues. It is important to note that the responsibility for compliance lies with the employer and their designated “plan fiduciary.” While vendors may assist in meeting the CAA's requirements, employers cannot delegate their fiduciary obligations.

3. Steps Employers Can Take for CAA Compliance: There are four key steps employers can take to comply with the CAA's fiduciary obligations and reduce legal exposure. These steps include:

   • Developing processes for evaluating vendor performance and avoiding conflicts of interest.

   • Requesting detailed compensation information from vendors.

   • Working with legal counsel to eliminate "gag clauses" from contracts, which restrict employers' access to healthcare cost and quality data.

   • Requesting plan-level prescription drug data collection (RxDC) data from the pharmacy benefit manager (PBM).

   As the post-CAA healthcare environment solidifies, employers are expected to leverage third-party intermediaries for insights and data around healthcare services.

Hub acquires seven Michigan agencies

By Claire Wilkinson - Hub International Ltd. said Thursday it has acquired Troy, Michigan-based Project Motown Holding Co., an agency platform that owns seven agencies.

Terms of the transaction were not disclosed. The acquisition comprises Johnston Lewis Associates Inc., Business Benefits Resource LLC, Joseph Aiello & Associates Inc., T. Souphis Insurance Consulting LLC, Custom Results Corporate Consulting, Creative Benefit Solutions and Health Insurance Consultants. Read Full Article…

VBA Article Summary

1. Acquisition of Project Motown: Hub International Ltd., a global insurance brokerage, announced the acquisition of Project Motown Holding Co., a platform based in Troy, Michigan that owns seven insurance agencies. The specifics of the transaction were not disclosed.

2. Included Agencies and Specializations: The acquisition incorporates seven agencies: Johnston Lewis Associates Inc., Business Benefits Resource LLC, Joseph Aiello & Associates Inc., T. Souphis Insurance Consulting LLC, Custom Results Corporate Consulting, Creative Benefit Solutions, and Health Insurance Consultants. These agencies, housed under Project Motown, employ over 60 individuals and specialize in areas such as commercial coverage, employee benefits, employer compliance requirements, human resources technology, employee wellness, and wealth management services.

3. Joining Hub Midwest East: The executive leaders of the acquired agencies, along with their staff, will now become part of Hub Midwest East. These executives include Joe Aiello, Jim Bokshan, Ed Clink, Diane Christensen, Greg Liposky, Steve McCain, Steve Rosser, Jay Sawmiller, Dan Wilhelm, and Ted Souphis.The Benefits of Adopting a Primary Care Model for Self-Funded Employers