Daily Insurance Report - June 30, 2023


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

Primary care compensation growth outpacing other specialties

By Rebecca Pifer - Recent primary care compensation increases are a bright spot for a profession that is integral for the provision of preventative medical care in the U.S., but faces notable challenges. Experts warn the U.S. primary care chassis is chronically underfunded and facing acute doctor shortages, problems that were amplified during COVID-19. Read Full Article…

VBA Article Summary

  1. Primary care physicians experienced a larger increase in compensation than other medical and surgical specialties in 2022. This rise is linked to significant E/M coding changes by the CMS and the stabilization of volume post-pandemic. In contrast to the 1.5% and 1.6% increases for medical and surgical specialties, primary care compensation saw a 6.1% increase. Despite the rising compensation, the revenue of medical groups grew faster, possibly due to addressing higher expenses like supply and labor costs​1​.

  2. The rise in primary care compensation is a positive development for a profession that's integral for preventative medical care in the U.S. but faces significant challenges like chronic underfunding and acute doctor shortages. The CMS's coding tweaks in 2021 have particularly benefited primary care doctors, with their work relative value units (wRVUs) increasing 4% from 2021 to 2022, compared to a median gain across specialties of just 2.9%​1​. This was largely due to an overhaul of the physician payment system by the CMS, which increased wRVU values for office-based E/M to include non-face-to-face work and recognize the time burden on doctors associated with medical documentation​1​.

  3. There are still concerns regarding the healthcare system. The nation's primary care workforce has shrunk due to rampant consolidation, closures, and neglect worsened during the pandemic. An estimated shortage of 55,000 primary care doctors by 2032 is predicted, and the financial health of practices has declined, prompting them to consolidate or close altogether. To address these issues, Congress is currently debating changes to existing physician payment systems to encourage providers towards value-based models and provide more reliable reimbursement​1​.

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National Enforcement Action Results in 78 Individuals Charged for $2.5B in Health Care Fraud

By The U.S. Justice Department - The Justice Department, together with federal and state law enforcement partners, announced today a strategically coordinated, two-week nationwide law enforcement action that resulted in criminal charges against 78 defendants for their alleged participation in health care fraud and opioid abuse schemes that included over $2.5 billion in alleged fraud. Read Full Article… 

VBA Article Summary

  1. The Justice Department, along with federal and state law enforcement partners, has conducted a nationwide two-week law enforcement action resulting in charges against 78 defendants for alleged participation in health care fraud and opioid abuse schemes, totaling over $2.5 billion in alleged fraud. The defendants are accused of defrauding programs intended for the care of the elderly and disabled and using the proceeds to purchase luxury items​1​.

  2. The enforcement action represents intensified efforts to combat fraud and prosecute those who profit from it. The Justice Department has demonstrated its commitment to fighting health care fraud by prosecuting those who allegedly exploit patients and health care benefit programs for personal gain. This includes some of the largest and most complex cases that the Department has prosecuted, targeting individuals at all levels of the healthcare industry who prioritize profits over patient care​1​.

  3. The enforcement action also included charges against 11 defendants in connection with the submission of over $2 billion in fraudulent claims resulting from telemedicine schemes. One of the cases involves the alleged organizers of one of the largest health care fraud schemes ever prosecuted​1​. Various agencies involved in the enforcement action have expressed their commitment to protect the health care system, patients, and public funds from such fraudulent activities, emphasizing the negative impact of these schemes on patients, the healthcare system, and taxpayer-funded programs​1​.

Recent Laws Heighten Risk of Lawsuits Against Health and Welfare Plan Fiduciaries

By Kutakrock - As discussed in our January 2022, November 2021, and January 2021 Client Alerts, the Consolidated Appropriations Act, 2021 (CAA), Transparency in Coverage Rule, and related U.S. Department of Labor (“DOL”) guidance impose new fiduciary duties on health plan fiduciaries. This Client Alert briefly summarizes the CAA’s disclosure provisions and rules regarding prescription drug and health plan reporting requirements as well as outlining the Transparency in Coverage rule. It then discusses how these policies open the door for litigation and steps fiduciaries can take to help protect themselves. Read Full Article…

VBA Article Summary

  1. The Consolidated Appropriations Act, 2021 (CAA), the Transparency in Coverage Rule, and the related U.S. Department of Labor guidance have imposed new fiduciary duties on health plan fiduciaries. These new policies have introduced potential avenues for litigation against health plan fiduciaries. The article details the CAA’s disclosure provisions and rules regarding prescription drug and health plan reporting requirements as well as the Transparency in Coverage rule​1​.

  2. The increased focus of federal regulators on fee and pricing transparency for health plans has sparked a new wave of litigation against health plan fiduciaries. The fiduciary duties for a healthcare plan sponsor are now similar to those of a retirement plan sponsor. A rising threat comes from plaintiffs claiming that fiduciaries breached their duties by not adequately receiving and reviewing broker and consultant service fee disclosures, not having proper procedures for hiring and monitoring third-party administrators and pharmacy benefit managers, or failing to determine that the health and prescription drug plan’s negotiated network discounts are reasonable and comparable to the claims experience of similar plans​1​.

  3. To mitigate their exposure to litigation and personal liability, health plan fiduciaries are advised to take several steps. These include forming a fiduciary committee if one does not exist, reviewing service and fee disclosures from health plan brokers and consultants, considering the reasonableness of broker and consultant compensation, benchmarking fees and claims experience for self-insured health plans, periodically requesting proposals from third-party administrators, brokers, consultants, pharmacy benefit managers, and other vendors, reviewing and negotiating administrative service agreements and pharmacy benefit management agreements, and documenting the process used to obtain, review, and monitor disclosures, benchmarking information, vendor proposals, and vendor performance​1​.

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MA enrollees see fewer inpatient stays, ER visits than those in traditional Medicare: report

By Frank Diamond - Medicare Advantage beneficiaries have fewer inpatient hospital stays and emergency department visits than beneficiaries in traditional fee-for-service Medicare, according to a report (PDF) by consulting company Avalere Health. In addition, MA beneficiaries have fewer chronic conditions, according to the analysis. Read Full Article…

VBA Article Summary

  1. MA (Medicare Advantage) serves a higher population of individuals with clinical and social risk factors, including a higher percentage of racial or ethnic minorities compared to FFS (fee-for-service) Medicare.

  2. MA beneficiaries with hypertension, hyperlipidemia, and diabetes spend less on healthcare, have more physician office visits, fewer hospitalizations, and visit emergency departments less frequently compared to FFS beneficiaries with the same conditions.

  3. Total spending is consistently higher among FFS beneficiaries compared to MA beneficiaries across all subgroups, indicating that MA is more cost-effective. Additionally, MA has experienced significant growth in enrollment over the past decade and is projected to account for 60% of Medicare beneficiaries by 2032.

The Importance of Effective Communication in the Workplace — and How AI Can Help Improve It

By Serge Antonie - It is no secret that running a business successfully requires effective communication between employees and management. However, this is an aspect that most businesses across the United States seem to be lacking in. According to a survey conducted by Grammarly and The Harris Poll in 2021, companies lose almost USD $1.2 trillion or USD $12,506 per employee each year due to poor internal communication. Read Full Article…

VBA Article Summary

  1. Improving Workplace Communication: It is crucial for successful business operations to have effective communication between employees and management. This aspect seems to be lacking in most businesses across the United States, and the recent trends of hybrid and remote work have only heightened this issue. Businesses need to devise effective means to resolve this problem. Some strategies for improving communication within an organization include using the right tools for communication, making no assumptions, and taking time to listen to the employees​1​.

  2. The Role of AI in Improving Workplace Communication: Artificial intelligence (AI) can serve as an effective solution to improving workplace communication. AI can be used to create an automatic system that takes notes during meetings, thus ensuring no miscommunication of facts. Virtual assistants can be used for routine HR tasks, providing employees with easy access to general organizational data. AI can also be used to troubleshoot internal communication issues and to collect and analyze employee feedback in real time, enabling leaders to take immediate action and provide prompt performance-related feedback to their workforce​1​.

  3. Additional AI Benefits: Beyond streamlining workplace communication, AI applications can help businesses conduct market research, handle clients, reply to emails, set meetings, and more. The use of AI can accelerate transparent and effective communication between departments, pushing the boundaries of what is currently known. It is time for businesses to accept this new "normal"​1​.

Amenities becoming a key element to health care facilities

By Richard Berger - Boosting amenities offerings are being given strong consideration for healthcare facilities as a way to create a more positive experience for the patient, leading them to be more likely to choose that provider thereafter, according to a new report from JLL. “Colocation of traditional medical office space with primary care or specialists could allow health systems to utilize their current real estate portfolio more fully, and if done well” could pay dividends, the report said. Read Full Article…

VBA Article Summary

  1. Preferences for Additional Amenities at Healthcare Facilities:

    • 63% of respondents expressed interest in visiting a healthcare facility for an additional amenity.

    • Gen Z and Millennials showed higher interest (80% and 77% respectively) compared to Gen X (62%) and Baby Boomers (44%).

    • Alternative medicine, such as chiropractors or acupuncturists, was the top choice for all age groups.

  2. Amenities Preferred by Different Generations:

    • Restaurants were the top choice for Gen Z and ranked high across all age groups.

    • Fitness centers were the second choice for Gen Z and Millennials, and the third choice for Baby Boomers.

    • Childcare and retail scored the lowest among the six amenity choices offered.

  3. Impact of Amenities on Patient Experience and Convenience:

    • Younger generations prioritize additional amenities and see them as complementary to medical needs.

    • Wholistic health and wellness campuses that include fitness, retail, and food services create a more engaging experience for patients.

    • Seniors benefit from amenities such as relaxation areas, fitness centers, nutrition classes, and advanced technology for better quality of life and healthy aging.

The State of Healthcare 2023: Is your benefits game plan working and designed to endure?

By Deanna Cuadra - Employers and employees alike are struggling to keep up with the cost of healthcare — and they won't see relief anytime soon. Now more than ever, choosing the right healthcare benefits can be cost and life-saving. New research from Arizent reveals whether employers and employees are on the same page, or if employers are failing to meet their workers' needs and should rethink their benefits game plan. Read Full Article… 

VBA Article Summary

  1. Healthcare costs continue to rise, and both employers and employees are struggling to keep up. The importance of choosing the right healthcare benefits has been underscored, as they can be cost-saving and even life-saving. There is a need to determine if employers and employees are aligned in their understanding and needs related to healthcare benefits, and if not, employers may need to reconsider their benefits strategies​1​.

  2. The research conducted by Arizent has uncovered key insights into how employers perceive their benefits, the tools they utilize to make benefits decisions, and whether there is agreement between employers and employees regarding the affordability of healthcare. Additionally, it assesses the satisfaction level of employees with their benefits despite the cost​1​.

  3. There are several barriers that employees may face when booking appointments for providers and receiving care. The study also investigated whether employees have effective healthcare navigation tools to deal with the complex and expensive U.S. healthcare system. Moreover, it looked into how the COVID-19 pandemic continues to impact employee health, workplace safety, and has left a lasting legacy on workplace culture and benefits​1​.

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A 16-year-old pocketed $50,000 for her award-winning discovery in the brains of people who died by suicide

By Adam Barnes - Natasha Kulviwat is no ordinary high schooler. Starting last August, she spent six months in the lab at Columbia University studying the brain tissue of people who died by suicide. Her research investigated if any biomarkers — physical and measurable substances in the brain — might help explain and, perhaps someday, prevent suicide. Read Full Article…

VBA Article Summary

  1. Natasha Kulviwat, a 16-year-old high school student, recently won $50,000 at the Regeneron International Science and Engineering Fair for her research on suicide prevention. She spent six months at a lab in Columbia University studying the brain tissue of people who died by suicide. Her research focused on identifying biomarkers that might explain and potentially prevent suicide. Specifically, she found that the brains of those who died by suicide contained higher numbers of inflammatory cytokines and elevated levels of a protein called claudin-5, suggesting a breakdown of the blood-brain barrier (BBB). The results indicate that elevated levels of claudin-5 in the brain might serve as a biomarker of suicide risk​1​.

  2. Suicide risk is typically evaluated based on factors like history of depression or other mental illnesses, life circumstances, and other subjective psychological factors. Despite the existence of treatments for suicidal behavior, suicide rates have generally increased over the last 20 years. In 2021, over 48,000 people died from suicide, and there were an estimated 1.7 million attempts. By identifying a physiological process involved in suicide, Kulviwat and other researchers hope to more accurately predict who is at risk than current methods and aid in developing more targeted pharmaceutical treatments for prevention​1​.

  3. Kulviwat has plans for further research, intending to examine how medications like anti-inflammatories interact with claudin-5 in an animal model. This research could provide insights into developing alternative treatments for BBB breakdown and suicide risk. Despite the recognition and prize money, she maintains her focus on her high school studies and aspirations to attend medical school in the future, aspiring to become a pediatrician or pediatric psychiatrist​1​.