MITRE’s Brian Anderson, M.D., Explains Coalition’s AI Blueprint

By David Raths - Coalition for Health AI envisions assurance labs that would evaluate AI in healthcare to assure that it is adherent to standards and performing appropriately. In April 2023 a group called the Coalition for Health AI (CHAI) published a blueprint for trustworthy artificial intelligence deployment in healthcare.  Read Full Article…

VBA Article Summary

1. The Coalition for Health AI (CHAI) published a blueprint for trustworthy AI deployment in healthcare in April 2023. The 24-page guide was developed by subject matter experts from academic medical centers, healthcare, technology, and other industry sectors, in collaboration with several federal agencies over the past year.

2. CHAI aims to establish shared principles for the development, implementation, and maintenance of AI in healthcare. The initiative recognizes the diverse range of AI use cases and applications in health systems, payers, and technology vendors. Through roundtable sessions open to the public, CHAI distilled down a set of shared principles to guide AI implementation.

3. CHAI emphasizes the importance of collaboration between the public sector, private sector, and the community in the development of AI standards. By including community activists and stakeholders from patient and family advocacy councils, CHAI ensures that industry and regulators understand best practice standards. This collaboration helps establish an informed relationship between industry, the public sector, and the community in the deployment of AI technologies in healthcare.

Drugmaker Mallinckrodt may renege on $1.7 billion opioid settlement

By Brian Mann - The generic drugmaker Mallinckrodt says the company's board might not make a $200 million opioid settlement payment scheduled for later this week. Mallinckrodt says it is considering its financial alternatives, including a second bankruptcy. Read Full Article…

VBA Article Summary

1. Mallinckrodt, a generic drugmaker, is considering not making a $200 million opioid settlement payment scheduled for later this week. The financially troubled company faces internal and creditor concerns about the payout, which is part of a $1.7 billion opioid deal reached during a bankruptcy agreement last year.

2. If Mallinckrodt files for a second bankruptcy, the entire settlement could be at risk. This move would likely prioritize payments to company executives, staff, and other creditors over opioid-related claims, potentially leaving individual victims with reduced compensation. Approximately $170 million in total compensation for victims could be lost, while the remaining funds were intended to support drug treatment and healthcare programs for state and local governments.

3. The potential failure to make the settlement payment is disheartening for individuals affected by the opioid crisis. It raises concerns about the prioritization of payments and the impact on victims who have suffered harm from Mallinckrodt's pain medications. The company's financial maneuver comes at a time when larger and more financially stable drugmakers, wholesalers, and pharmacy chains have agreed to pay over $50 billion in settlements related to the prescription opioid crisis.

Compromise struck to preserve Obamacare’s preventive care mandate

By Alice Miranda Ollstein  - The deal reached between the DOJ and Texas challengers could maintain insurance coverage of HIV drugs and other services nationwide. Their suit also claims the requirement for insurance to cover the pre-exposure prophylaxis pill used to prevent transmission of HIV — known as PrEP — violates the religious rights of the challengers. Read Full Article… 

VBA Article Summary

1. A tentative compromise has been reached between the Texas conservatives challenging Obamacare's preventive care mandate and the Justice Department. The compromise, pending approval from the 5th U.S. Circuit Court of Appeals, maintains free coverage for a variety of services, including depression screenings and syphilis tests. As part of the agreement, the Biden administration promised not to enforce the mandate to cover HIV prevention drugs and other preventive care services against the employers and individual workers who sued, asserting that doing so violated their religious beliefs​¹​.

2. The challengers, represented by Jonathan Mitchell, architect of the Texas abortion ban, aim to eliminate the preventive care mandate in its entirety. They argue that the recommendations of the United States Preventive Services Task Force, comprised of non-Senate-confirmed external experts, regarding what services insurance should cover, must be "set aside" and can't be enforced. The challengers' lawsuit also asserts that the requirement for insurance to cover PrEP (pre-exposure prophylaxis), a pill used to prevent HIV transmission, infringes upon their religious rights​¹​.

3. The compromise currently supersedes a nationwide ruling from Texas District Court Judge Reed O’Connor that invalidated all decisions made by the United States Preventive Services Task Force since 2010 concerning what insurers must cover without cost-sharing. The 5th Circuit Court heard oral arguments on the case recently, and a ruling is anticipated in the coming months. An appeal to the U.S. Supreme Court is expected regardless of the outcome​¹​.

How Penn Medicine’s Telemedicine Program Saved It $113 Per Patient Visit

By Katie Adams - Penn Medicine recently published a study on the economics of providing telemedicine — it showed that when the health system began offering virtual urgent care services to its employees, the visits ended up being 23% less expensive to conduct than in-person appointments. Read Full Article…

VBA Article Summary

1. Penn Medicine published a study on the economics of their telemedicine program, demonstrating that virtual urgent care services were 23% less expensive to conduct than in-person appointments​¹​.

2. The study revealed that the per-visit costs for Penn Medicine's telemedicine program, OnDemand, averaged $380, compared to $493 for in-person visits, resulting in a $113 difference per patient. Despite an increase in telemedicine demand, there was a 23% reduction in the overall "unit cost" per service, making telemedicine less expensive and more accessible for Penn Medicine employees. The authors argued for more health systems to offer in-house telemedicine programs, leveraging existing providers for in-system referrals and better coordinated follow-up care​¹​.

3. The lead study author, Krisda Chaiyachati, stated that the value of direct-to-consumer telemedicine services offered by academic health systems is an understudied topic and that cost savings could potentially be even higher now that patients are more comfortable with telemedicine. Penn Medicine's telemedicine program started by serving only the health system's employees but later opened up to insured patients a few months before the pandemic​¹​.

Employers know their mental health benefits aren’t cutting it

By Alyssa Place - As the U.S. continues to face a behavioral health provider shortage, employers are feeling frustrated that they can't do more to help employees. According to a survey by the National Alliance of Healthcare Purchaser Coalitions and the HR Policy Association, just one-third of employers were satisfied with access to behavioral health services through their network. Read Full Article… 

VBA Article Summary

1. A survey by the National Alliance of Healthcare Purchaser Coalitions and the HR Policy Association revealed that a significant number of employers are dissatisfied with access to behavioral health services through their network. Only one-third of employers were content with the access provided, and 31% were disappointed with the attempts to address gaps in access. About 66% felt that their behavioral health directories did not accurately represent what was available to employees​¹​.

2. The article highlights the growing need for behavioral health care services, with 86% of employees having experienced a mental health challenge in the past year. Despite this, only 33% were able to access care, and a third said their benefits didn't adequately meet their needs. The shortage of behavioral health professionals, including therapists and psychiatrists, has led to long wait times, misdiagnoses, and other barriers to care​¹​.

3. Despite the challenges, telehealth and behavioral health coaching services have surged to address these gaps, with 95% of employers acknowledging their importance and 65% feeling satisfied that these services are meeting their employees' needs. However, engagement remains a problem, with 61% of employers still dissatisfied with employee involvement in these offerings. Additionally, access to mental health care is even harder for marginalized communities such as BIPOC and LGBTQ workers, and only 27% of surveyed organizations were satisfied that their service providers are tailoring their benefits to diverse communities​¹​.

How to make the business case for employee well-being programs

By ArmadaCare - Are your employees stressed? They’re not alone. Eighty-four percent of employees have experienced at least one mental health challenge this year. Stress is normal, whether it’s related to work, life or balancing both. But ongoing high stress can have serious consequences that underscore the business case for effective well-being support. Read Full Article… 

VBA Article Summary

1. Employee well-being is not just a people priority, but also a business one. With 59% of employees saying their struggles affect them at work, 71% of employers saying worsening employee mental health is affecting company financial performance, and 75% of employees admitting to suffering from burnout, it's clear that employees who are struggling are twice as likely to leave their jobs​¹​.

2. To effectively support whole-person health, organizations can take several steps. These include focusing on education to reduce the stigma around seeking care, creating a company culture that prioritizes employee well-being, and removing barriers to care by providing employees with the benefits they need. An understanding of mental health's ups and downs and the provision of confidential, effective resources tailored to individual needs can aid in boosting well-being and stress management, thereby creating a healthier, happier, and more productive workforce​¹​.

3. Overcoming barriers to seeking care, particularly financial ones, is critical. Many primary healthcare insurance plans do not include mental health coverage, leading to financial strain. HR leaders should evaluate the primary healthcare plan to identify coverage gaps and potential barriers to effective care. Moreover, aligning the benefits offered with the company's narrative, including comprehensive mental health and well-being benefits, and providing guidance, access to resources, and proactive ways to deal with stress are necessary measures. The goal should be to find an all-in-one solution that combines coverage and access to support, protecting both employees and the business​¹​.

Core Specialty makes medical stop-loss buy

By Claire Wilkinson - Core Specialty Insurance Holdings Inc. said Monday it has formed a medical stop-loss division by acquiring Standard Life and Accident Insurance Co., the medical stop-loss managing general underwriter unit of American National Group. Read Full Article… 

VBA Article Summary

1. Core Specialty Insurance Holdings Inc. has formed a medical stop-loss division by acquiring Standard Life and Accident Insurance Co., which is a medical stop-loss managing general underwriter unit of American National Group​¹​.

2. Jim Stelling, who previously served as the executive vice president, health insurance, and specialty markets groups operations at American National Insurance Co., is set to join Core Specialty as the president of the new division​¹​.

3. Core Specialty plans to acquire 100% of the stock of Standard Life and Accident in a cash deal that also involves certain reinsurance transactions. Standard Life and Accident, based in League City, Texas, has about 15 employees and generated over $300 million of gross premium income in 2022. The deal is expected to close in the fourth quarter and Standard Life and Accident will maintain its League City location after the deal closes​¹​.