Daily Insurance Report - June 2, 2023

Medicare to broaden coverage of Alzheimer’s drugs after full FDA approval, but with some restrictions

By Heather Landi Jun 1, 2023 11:00am - The Centers for Medicare and Medicaid Services outlined plans Thursday to broadly cover a new class of Alzheimer’s drugs once the medications get full approval from the Food and Drug Administration. The new proposal does require patients participate in registries that collect data. Read Full Article…

VBA Article Summary

1. The Centers for Medicare and Medicaid Services' (CMS) New Coverage Plan: The CMS has plans to broadly cover a new class of Alzheimer’s drugs, provided these medications get full approval from the Food and Drug Administration (FDA). Eisai’s Leqembi is the first drug potentially covered by this expanded plan, and CMS would cover the expensive medications for patients enrolled in Medicare Part B, provided they meet certain criteria, including the participation of physicians and clinical teams in registries to collect evidence on drug effectiveness.

2. Registry Requirement and Criticism: One of the key requirements for coverage is patients' participation in registries that collect data. This approach has sparked controversy, with the Alzheimer's Association labeling the requirement as an "unnecessary barrier" that could hinder patient access to treatment. Despite the criticism, CMS defends the use of registries as tools to gather crucial real-world evidence, citing successful examples from the past such as the transcatheter aortic valve replacement (TAVR).

3. Impact on Pharma Companies and Patients: The broader coverage by CMS will significantly benefit pharmaceutical companies like Eisai, Biogen, Eli Lilly, and other earlier-stage players in the anti-amyloid space, according to analysts. This is crucial as over 5 million Medicare beneficiaries suffer from Alzheimer's disease. Despite concerns about registry requirements, analysts believe that these will not pose a significant hurdle, especially as monitoring via MRIs and tracking cognitive outcomes are part of the real-world use of these drugs.

PBMS, The Brokers Who Control Drug Prices, Finally Get Washington’s Attention

By Arthur Alan - For two decades, patients and physicians eagerly awaited a lower-cost version of the world's bestselling drug, Humira, while its maker, AbbVie, fought off potential competitors by building a wall of more than 250 patents around it. Read Full Article…

VBA Article Summary

1. Pharmacy Benefit Managers (PBMs), such as OptumRx, CVS Caremark, and Express Scripts, control around 80% of prescription drug sales in the U.S., with their pricing decisions often being opaque and affecting a wide range of stakeholders. These entities are part of larger health conglomerates and often make decisions that prioritize their own profits, which has led to increased scrutiny from Congress and the administration​1​.

2. The article highlights several issues attributed to PBMs. For instance, independent pharmacists have complained about unfair reimbursements and opaque rules, which led them to return $12.6 billion to PBMs in 2021. In addition, PBM pricing decisions have been found to be costly for Medicare, with a study revealing that Medicare could have saved $2.6 billion in 2018 if it had purchased certain generic drugs from Costco instead of through PBMs. Moreover, PBMs' practices are blamed for high drug prices, driving independent pharmacies out of business, and causing unpredictable prescribing decisions​1​.

3. There are several legislative initiatives aimed at regulating PBMs. Bipartisan bills in both the House and Senate aim to require PBMs to reimburse pharmacies serving Medicaid patients based on an authorized price list, which could save the federal government an estimated $1 billion over 10 years. Another Senate bill would require PBMs to report more of their earnings to the Federal Trade Commission (FTC) and ban deceptive and unfair fees. However, PBMs have shown adaptability in finding ways around regulation, leading some to believe that antitrust law could be a potential tool against PBMs​1​.

How Employee Benefits Will Shift in the Next 3 Years

By Bob Gaydos - Starting in 2021, a movement known as the Great Resignation swept through the U.S. workforce, leading to millions of employees quitting their jobs and finding new employment at an unparalleled rate. COVID-19, economic fluctuations, and declining job satisfaction all played a big part in this, with employees now displaying a far higher willingness to switch employers when their needs are not being met. Read Full Article…

VBA Article Summary

1. Increased Emphasis on Remote Work: The COVID-19 pandemic has caused a shift towards remote work, and it's likely here to stay. Employees, particularly Millennials and Gen-Z workers, have shown a strong preference for flexible scheduling and working remotely. Employers will need to adapt to this trend and offer adequate support and training for remote workers to reap the productivity benefits that come with employee satisfaction​1​.

2. Greater Portability of Benefits: Employees are increasingly demanding access to supplemental individual insurance policies that can transfer with them when they change jobs. This means moving away from one-size-fits-all group policies, which often have meager payouts and can't be transferred, towards a wider variety of customizable policies, including disability insurance, pet insurance, and supplemental life insurance. This shift will enable employees to choose benefits that best meet their needs and preferences​1​.

3. Novelty in Employee Benefits: The Great Resignation that started in 2021 has led to a higher willingness among employees to switch employers when their needs are not met. In response, employers have begun offering unique benefits, such as more flexible work-from-home schedules, increased access to voluntary benefits, and a greater focus on wellness programs. This trend will continue and expand over the next few years, making it crucial for life and health insurance agents to develop competitive insurance offerings that align with the evolving needs of employees​1​.

Empathy and Majesco Partner to Provide Innovative Tech to Benefit Life Insurance Carriers and Beneficiaries

By Business Wire May 31, 2023 - Majesco, a global leader of cloud insurance software solutions for insurance business transformation, today announced a new partnership with Empathy, the innovator behind the leading platform that helps families navigate the emotional and logistical challenges of loss. This partnership will provide life insurers with tech-powered services to aid them in delivering comprehensive bereavement support to beneficiaries. Read Full Article…

VBA Article Summary

1. Majesco, a global leader in cloud insurance software solutions, and Empathy, a platform focused on helping families navigate the challenges of loss, have announced a partnership. Their goal is to elevate the beneficiary experience by providing life insurers with technology-enabled services for comprehensive bereavement support. Empathy's research has highlighted the financial and emotional strain of bereavement, noting that families often spend around $5,000 on related legal matters while less than 15% have access to life insurance or dedicated funds to settle the estate​1​.

2. Ron Gura, Co-Founder & CEO of Empathy, emphasized the importance of building trust and loyalty with beneficiaries by acknowledging and providing support for the burdens they face. He suggests that life insurers can play a significant role in assisting bereaved families as they navigate the emotional and logistical challenges of loss. By partnering with Majesco, Empathy aims to simplify the implementation of their services with insurers of all sizes, transforming transactions into relationships and providing long-term support to families​1​.

3. Both Empathy and Majesco offer unique solutions to insurance companies seeking to better support their beneficiaries. Majesco's SaaS solutions are used by over 350 insurers, from startups to global companies, while Empathy's bereavement care platform provides comprehensive grief care and administrative assistance. Ray Law, SVP & GM of Products at Majesco, noted that understanding how insurance providers can improve operationally and create long-term value for beneficiaries, especially during their most difficult moments, is an evolving area. This partnership aims to maximize the support offered to beneficiaries by selecting innovative partners like Empathy​1​.

Patients admitted on weekends have higher in-hospital mortality than those admitted on weekdays: Analysis of national inpatient sample

By Augustine Manadan, Shilpa Arora, Millan Whittier, Ehizogie Edigin, and Preeti Kansal | June 2023 - Since the 1999 Institute of Medicine report, hospitals have implemented a myriad of measures to protect patients from medical errors. At this point, looking beyond errors may bring additional safety benefits. This study aims to analyze predictors of in-hospital death regardless of underlying diagnoses in an effort to identify additional targets for improvement. Read Full Article…

VBA Article Summary

1. The research studied the predictors of in-hospital death by analyzing the data of 121,026,484 adult hospital discharges from the National Inpatient Sample (NIS) database between 2016 and 2019. The variables that were associated with a higher in-hospital death rate included age, Charlson Comorbidity Index, male gender, lower income quartiles (Q1 and Q2), hospital location in the west region, non-elective admission, urban hospital location, and weekend admission.

2. The results of the study showed that weekend hospital admissions were associated with higher adjusted mortality and a lower rate of procedures compared to weekday admissions. This suggests the need for further studies to investigate if improved staffing and procedural availability on weekends could enhance hospital outcomes.

3. Detailed data analysis revealed that deceased patients were older, predominantly male, had a higher median Charlson Comorbidity Index, were more likely to be admitted on the weekend, non-electively, and in urban locations. These patients also had higher total hospital charges, a longer length of stay, were more likely to have Medicare, less likely to have Medicaid or private insurance, and had a higher rate of billed procedures.

The Benefits of Adopting a Primary Care Model for Self-Funded Employers

By Corporate Wellness Magazine - In today's fast-paced corporate world, the health and well-being of employees have become paramount. As organizations continue to explore innovative approaches to improve employee wellness, adopting a primary care model for self-funded employers has emerged as a highly effective solution. By prioritizing comprehensive primary care within the workplace, companies can significantly enhance employee health outcomes, reduce healthcare costs, and foster a positive work environment. In this article, we will explore the numerous benefits of implementing a primary care model and how it can revolutionize your organization's wellness program. Read Full Article…

VBA Article Summary

1. Improved Access to Quality Care and Enhanced Preventive Care: Adopting a primary care model enhances access to quality healthcare services for employees and emphasizes preventive care. By having healthcare professionals directly within the workplace, employees can receive timely and convenient care, which can lead to better health outcomes and increased productivity. Primary care providers can develop a deep understanding of each employee's medical history and specific health needs, allowing for more accurate diagnoses, appropriate treatment plans, and better coordination of care. Preventive care measures such as regular health check-ups, vaccinations, and health screenings can proactively identify health risks and provide early interventions, reducing healthcare costs and absenteeism​1​.

2. Comprehensive Wellness Programs: A primary care model aligns with comprehensive wellness programs, enabling employers to offer a holistic approach to employee well-being. Such programs can include initiatives like nutrition counseling, stress management workshops, fitness classes, mental health support, and more. By integrating primary care with wellness programs, employers can address a wide range of health concerns and foster a culture of well-being throughout the organization. Primary care providers can collaborate with wellness program coordinators to tailor initiatives that align with employees' needs and preferences, offering support, guidance, and resources to help them achieve their health goals​1​.

3. Cost Savings, Increased ROI, and Enhanced Employee Engagement: Adopting a primary care model can lead to significant cost savings for self-funded employers by reducing expensive emergency room visits and unnecessary specialist consultations. Early identification and management of health conditions can prevent costly hospitalizations and treatments, contributing to a higher return on investment for the organization's healthcare expenditures. Furthermore, the cost savings achieved through a primary care model can be reinvested into enhancing wellness programs and other employee benefits. The adoption of this model demonstrates a commitment to employee well-being, leading to increased employee engagement, reduced absenteeism, and improved overall well-being. When employees feel that their employer prioritizes their health, they are more likely to be motivated, loyal, and productive​1​.

Missouri nonprofit health systems BJC HealthCare, Saint Luke's targeting $10B merger

By Dave Muoio May 31, 2023 - BJC HealthCare of St. Louis and Saint Luke’s Health System of Kansas City are exploring a merger that would yield a 28-hospital, $10 billion, integrated, academic health system, the nonprofits announced Wednesday. Read Full Article…

VBA Article Summary

1. BJC HealthCare and Saint Luke’s Health System have signed a non-binding agreement to merge, creating a $10 billion health system serving patients in Missouri, Kansas, and Illinois. This combined entity would be a 28-hospital system, keeping their current brands and operating from two headquarters. The St. Louis base would focus on eastern Missouri and southern Illinois, while the Kansas City, Missouri, headquarters would serve western Missouri and parts of Kansas. They plan to reach a definitive agreement in the coming months, provided there are no regulatory hurdles, and expect the deal to close by the end of the year​1​.

2. Both BJC and Saint Luke’s currently operate 14 hospitals each. They had previously partnered as part of the BJC Collaborative, a group of systems that formed in 2012 with the aim to pool resources to reduce costs and improve quality and population health across neighboring systems​1​.

3. If the deal closes, Richard Liekweg, the current president and CEO of BJC, will serve as chief executive of the combined system. The initial board will come from Saint Luke’s. Liekweg believes that amid the rapidly changing healthcare landscape, this is the right time to build on their established relationship with Saint Luke’s. With an even stronger financial foundation, they plan to further invest in their teams, advance the use of technologies and data to support providers and caregivers, and improve the health of their communities​1​.