US outpaces other wealthy nations in cost-related care deferment, with wide gaps between income levels

By Dave Muoio - Another international survey has painted Americans’ access to care in a poor light when compared to those living in other wealthy countries, particularly when looking at disparities in residents’ income levels. Read Full Article…

VBA Article Summary

1. Significant Income-Related Healthcare Gaps in the U.S.: The Commonwealth Fund's summer poll revealed stark differences in healthcare utilization between individuals with higher and lower incomes across nine countries. The U.S. stood out with the highest percentage of respondents (46% of those with average or lower incomes) avoiding medical care due to costs. This figure significantly exceeds that of other surveyed countries like New Zealand, the U.K., Netherlands, Germany, and France.

2. Wide Disparities Across Healthcare Types: The survey indicated notable income-based disparities in the U.S. in accessing different types of healthcare. For instance, 46% of Americans with low or average incomes skipped dental care due to costs, compared to 24% of higher earners. Mental healthcare also showed a significant gap, with 21% of lower-income versus 14% of higher-income Americans avoiding it due to costs.

3. Broader Implications of Health Care Affordability and Coverage: The Commonwealth Fund's findings highlight the extensive income-related disparities in healthcare affordability in the U.S., underscoring the lack of universal health coverage and limited caps on out-of-pocket expenses. The report points out that even in countries with more comprehensive healthcare systems, ensuring affordable and comprehensive coverage remains a challenge. The latest data adds to the evidence suggesting that the U.S. healthcare system is underperforming compared to other high-income nations, with widespread issues related to healthcare affordability and debt.

5 Questions Providers Must Ask to Ensure More Equitable AI Deployment

By Katie Adams - Over the past few years, a revolution has infiltrated the hallowed halls of healthcare — propelled not by novel surgical instruments or groundbreaking medications, but by lines of code and algorithms. Artificial intelligence has emerged as a power with such force that even as companies seek to leverage it to remake healthcare — be it in clinical workflows, back-office operations, administrative tasks, disease diagnosis or myriad other areas — there is a growing recognition that the technology needs to have guardrails. Read Full Article…

VBA Article Summary

1. Increasing Need for Robust AI Framework in Healthcare: The rapid advancement of generative AI is leading to its greater integration into healthcare. The complexity and high stakes in this field demand a robust framework for AI deployment, as mistakes can have serious repercussions. Xealth CEO Mike McSherry highlights the challenges of introducing AI at an experimental level in healthcare, underscoring the necessity for careful implementation.

2. The Formation of VALID AI Collective and Importance of Data Diversity: Over 30 health systems and payers have formed VALID AI to explore generative AI use cases, risks, and best practices in healthcare. Key concerns include ensuring AI models are trained on diverse datasets to prevent biases and enhance their effectiveness across different patient demographics. The failure of IBM Watson Health, partially due to its training on non-representative data, serves as a cautionary tale.

3. Considerations for AI Deployment in Healthcare: Several considerations must be addressed for AI deployment in healthcare, such as prioritizing value in AI applications, ensuring compliance with patient consent and cybersecurity, maintaining a human in the loop for clinical decision-making, and regularly benchmarking AI models to ensure their continued effectiveness. These steps are crucial for the responsible and ethical adoption of AI in healthcare, emphasizing the importance of balancing innovation with patient safety and trust.

Foot Locker, Teamsters Show Their Drug-Benefit Managers the Door

By Melanie Evans - Employers and unions are getting fed up with the firms they have used for years to help control their spending on prescription drugs—because their costs keep soaring. Footwear retailer Foot Locker dropped UnitedHealth Group’s OptumRx drug-benefit manager last year, while a Teamsters fund in Philadelphia recently reupped with its replacement for CVS Health’s Caremark. Read Full Article…

VBA Article Summary

1. Cost Concerns and Transparency Issues: Employers and unions are frustrated with being compelled to cover more expensive drugs when cheaper alternatives exist. This issue is partly attributed to the lack of transparency from drug-benefit managers (PBMs) regarding their fees and revenue sources. For instance, Alabama's Phifer, after replacing its PBM, managed to significantly reduce costs by opting for less expensive drugs, like substituting a $1,532 nerve-pain medicine with a $13 generic equivalent.

2. Changing PBM Strategies and Savings: Companies like Foot Locker and the Teamsters Health and Welfare Trust Fund have switched PBMs to ones offering more transparency and savings. For example, Foot Locker moved to Navitus Health Solutions, which prioritizes low-cost prescriptions and provides 100% of the drug rebates it negotiates to employers. This move resulted in a 5% decrease in drug spending for Foot Locker. Similarly, Phifer's switch to MedOne Pharmacy Benefit Solutions led to an 18% reduction in drug spending.

3. Industry Response and Market Dynamics: Large PBMs like Caremark, OptumRx, and Express Scripts argue they save customers money and provide information to tailor drug benefits. Despite this, there's growing discontent among employers and unions over increasing drug costs, with average annual increases of 3% under private insurance. This dissatisfaction is prompting a shift towards PBMs offering more transparency and cost-effective strategies, potentially reshaping the sector responsible for managing a significant portion of retail prescription drug spending.

What Generative AI Offers the Insurance Industry

By Atif Khan - The buzz surrounding generative AI has permeated every industry, and the insurance sector is no exception. With capabilities such as creating human-like responses and generating insightful outputs, generative AI technologies have brought forth a unique blend of opportunities and challenges for organizations. Read Full Article…

VBA Article Summary

1. Strategic Relevance and Future Implications of Generative AI in Insurance: The article underscores the significant impact of generative AI on various aspects of business operations, such as content creation, risk management, and customer service in the insurance industry. Paul Carroll's commentary highlights the need for a balanced perspective in understanding the short-term and long-term implications of these technologies. The emphasis is on the common misjudgment of breakthrough technologies: overestimation in the short term and underestimation in the long term.

2. Enhancing Customer Communications and Emotional Responsiveness: The use of generative AI, particularly in customer communications, is highlighted. The technology's ability to rewrite content in plain language and adjust the emotional tone of communications, especially in sensitive situations like claim denials, is emphasized. This capability is crucial given that a significant portion of the U.S. population reads at or below an eighth-grade reading level, and the impact of negative language on stress and comprehension is notable.

3. The Role of Technology Partners in Amplifying Business Needs with AI: The article discusses the importance of selecting the right technology partner for implementing generative AI in the insurance sector. This partner plays a critical role in navigating the complexities of the technology, including regulatory, ethical, and data security considerations. The evolving nature of the insurance industry, with its regulatory changes and shifting market trends, necessitates a technology partner that can ensure AI applications are compliant, scalable, and adaptable for future needs, emphasizing the concept of AI implementation as a continuous journey rather than a one-off project.

When doctors ‘steer’ patients toward affiliated health systems, costs increase

By Alan Goforth - Changes in health-care payments and demand for coordinated care have led to an increase in vertical relationships between physicians and health systems in recent years. Read Full Article…

VBA Article Summary

1. Benefits and Consequences of Vertical Consolidation: The study in JAMA Health Forum highlights that vertical relationships between primary care physicians and large health systems can lead to improved care coordination, potentially reducing unnecessary testing and emergency department visits. This can enhance the quality of care and decrease spending. However, these relationships might also disrupt established patient-physician relationships and referral patterns, potentially lowering the quality of care.

2. Impact on Healthcare Utilization and Spending: Researchers found that vertical consolidation leads to more specialist visits, emergency department visits, and hospitalizations within the associated health systems, suggesting a trend of "steering" patients within the network. This integration led to increased overall medical spending per patient year. Despite this, there was no significant evidence that these relationships contributed to reduced readmissions or directed patients to hospitals with lower readmission rates.

3. Policy Considerations and Alternative Approaches: The report suggests that vertical relationships do not unequivocally improve healthcare access or coordination. Policymakers and regulators are advised to consider various strategies to mitigate the negative effects of vertical consolidation on healthcare costs. These include enforcing antitrust laws, promoting transparency, encouraging patients to seek care from lower-cost providers, and implementing alternative payment models that incentivize the use of more cost-effective care options.

Employers Largely Underestimate Employees’ Caregiving Responsibilities

By Remy Samuels - ​More than 53 million Americans, or about one out of every five adults, currently provide uncompensated care to their spouses, partners, parents or children living with serious health problems or disabilities. Read Full Article…

VBA Article Summary

1. Workplace Impact of Caregiving: The TIAA Institute report highlights that caregiving is a significant workplace issue often underestimated by employers. About 60% of caregivers are employed outside the home, and they face substantial financial challenges, such as an average of $7,200 per year in out-of-pocket expenses, higher debt levels, and lower financial assets. This situation often leads to early retirement or leaving the workforce.

2. Misalignment of Employer Benefits and Caregiver Needs: The report emphasizes a disconnect between what employers offer and what caregivers need. While 51% of employers provide flexible scheduling, a higher percentage of caregivers would prefer to use such benefits, including paid family medical leave and remote work options. This misalignment affects productivity, costing an estimated $5,600 per employee annually in productivity losses.

3. Recommendations for Employers to Support Caregivers: TIAA advises employers to better assess the caregiving needs of their workforce, potentially using tools like the Caregiving Intensity Index. Suggested improvements include offering benefits aligned with caregivers' needs, such as flextime and paid family leave, and providing continual access to retirement planning services that take into account the financial implications of caregiving.

Drug ads must be more upfront about side effects, FDA says

By Adriel Bettelheim - The Food and Drug Administration has finalized a long-running effort to require prescription drug ads on TV and radio to clearly lay out potential side effects and when a person should avoid a medicine. Read Full Article…

VBA Article Summary

1. Surge in Drug Ads and Consumer Impact: The article highlights the significant increase in direct-to-consumer (DTC) drug advertisements, noting their reliance on emotional appeals and a focus on benefits over risks. These ads, only legal in the United States and New Zealand among developed nations, can significantly influence consumer behavior, including prompting discussions with healthcare providers or even bypassing medical advice.

2. FDA's New Standards for Drug Ads: The FDA has introduced five new standards to improve these advertisements. Key among these is the use of consumer-friendly language and the requirement for TV ads to include clear, easily readable concurrent text messages. These measures aim to balance the lack of business incentive for drug companies to communicate product risks effectively.

3. Limitations and Industry Response: The new FDA requirements are limited to prescription drugs, with over-the-counter drug advertising still under the Federal Trade Commission's purview. The pharmaceutical industry defends its advertising practices as providing valuable health information. However, the article notes concerns about information overload for consumers and historical instances of misleading advertising, such as during the opioid epidemic and with risky weight-loss treatments.

Why GLP-1s Alone Cannot Solve the Obesity Crisis

By Rajesh Aggarwal  - GLP-1s are making headlines and are in high demand for their ability to help people lose weight, with five million prescriptions written in 2022. For many people who’ve struggled with obesity, they represent a transformational clinical advance. But what happens if the meds are no longer taken, whether due to high cost or side effects? The weight often comes back, sometimes with a vengeance. Any siloed approach to weight loss – whether it’s medication, behavioral changes, or surgery – is not the answer. Instead, what’s needed is a multimodal and holistic approach. Such a sustainable weight loss model does what an injection alone cannot do – keep the weight off and support a person’s overall health. Read Full Article…

VBA Article Summary

1. Obesity Epidemic and Current Treatments: The United States faces a significant obesity crisis, with 42% of adults currently obese, a figure expected to rise to nearly half by 2030. This condition is linked to a host of health issues, including arthritis, heart disease, stroke, diabetes, sleep apnea, mental health disorders, orthopedic problems, and certain cancers, leading to massive healthcare costs and reduced life expectancy. Despite these alarming statistics, only a small fraction of those affected opt for bariatric surgery, an effective treatment for some with a Body Mass Index (BMI) over 30.

2. GLP-1s: A Promising but Limited Solution: GLP-1s, initially developed for Type 2 diabetes, show promise in treating obesity by reducing appetite and improving insulin sensitivity. However, their high cost, up to $1,200 per month, poses a significant barrier, and there are concerns about long-term effectiveness and cost implications for healthcare systems. The limited data on their ability to reduce healthcare costs and improve health outcomes has led some employers and health plans to resist covering them, fearing unsustainable budgets and increased premiums.

3. A Comprehensive Approach to Obesity Management: Recognizing obesity as a complex disease rather than a character flaw, medical experts advocate for a multimodal treatment approach, combining behavioral, nutritional, exercise, medication, and surgical interventions. This holistic method, similar to oncology care, tailors treatments to individual needs and includes GLP-1s for some patients. The medical community emphasizes the need for a coordinated approach to obesity treatment, integrating various therapeutic methods to effectively manage this multifaceted disease.