Daily Insurance Report - November 9, 2023

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

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Hear from former IRS Deputy Associate Chief Counsel (Employee Benefits) and Special Counsel for the US Department of Treasury on not one but two Legislative Update sessions:

  1. Understanding the Dynamic Federal Employee Benefits Legislative Landscape

  2. Understanding the Dynamic Legislative LTC & “Junk Insurance” Landscape

Lastly, join us for a fast-paced presentation The Medicare Minefield & Medicare Decoded in which we’ll cover all the elementary components of Medicare Part A through Part D. We will also cover the nine most misunderstood facts of Medicare, and all the mistakes and pitfalls that most seniors and their caregivers are typically unaware of.

VBA Poll Question - Please share your insights

Do you believe that the healthcare benefits your company offers to employees are affordable and sustainable for your organization?

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Our last poll results are in!


of Daily Insurance Report readers who responded to our last poll stated that the cost of their health plan renewal remained the same.

28% that responded said the cost of their health plan renewal will significantly increase, 14% said their cost will slightly increase, while only 9.23% said the cost of their health plan renewal decreased.

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Increases in value-based payment adoption decreased family physician burnout, AAFP study finds

By Annie Burky - Family physicians utilizing value-based payment (VBP) models reported burnout relief in a new study from EHR company Elation Health and the American Academy of Family Physicians (AAFP). Read Full Article…

VBA Article Summary

  1. Threshold for Decreased Burnout in VBP Models: The study, a collaboration between Elation and AAFP’s Innovation Lab, demonstrates a pivotal finding that burnout among healthcare providers significantly decreases once a practice invests 75% or more in Value-Based Payment (VBP) models. This threshold marks a turning point in reducing burnout, while practices that haven't reached this level of VBP adoption experience increased burnout. This finding underscores the impact of financial investment in VBP models on healthcare providers' well-being.

  2. Challenges and Strategies in VBP Adoption: The study surveyed 10 diverse practices, revealing the complexities of adopting VBP models. It noted that larger practices and those with network affiliations, benefiting from economies of scale, find it easier to manage VBP administration. The study also found that the transition phase, especially when practices are partially (59% to 75%) invested in VBP, is particularly challenging, leading to increased burnout due to the dual demands of managing both fee-for-service and VBP models. Sara Pastoor from Elation Health suggests that smaller practices can achieve quicker and easier adoption of VBP by joining collaborative networks, which allows for shared savings and reduced administrative burdens.

  3. Financial Feasibility and Future Trends in VBP: The study also sheds light on the financial aspects of VBP, emphasizing that the success of these models depends greatly on the quality of the contract, particularly in capitation rates. Practices with contracts offering inadequate capitation rates struggle despite adopting VBP models. Pastoor observes an industry-wide trend of experimentation with various payment arrangements, reflecting a reluctance to return to traditional fee-for-service models despite the challenges in implementing VBP effectively. The study's insights into these financial and contractual nuances are crucial for practices considering or already transitioning to VBP models.

Healthcare financial strain is ‘widespread’ in U.S., study

By Emily Olsen - The latest study highlights the growing burden of U.S. healthcare costs, which can restrict access to care and worsen health outcomes. Health affordability is a challenge for a wide swath of working-age Americans, even those with health insurance, according to a recent survey by the Commonwealth Fund. Read Full Article…

VBA Article Summary

  1. Prevalence of Financial Strain in Healthcare: The Health Affairs study highlights that 27% of non-elderly adults in the U.S. experienced significant financial strain due to healthcare costs. This strain was defined by high out-of-pocket expenses relative to income, problematic medical debt, or barriers to accessing care. The issue is notably widespread, impacting people across various income levels, though disproportionately affecting those with lower incomes.

  2. Insurance Coverage and Affordability: The type of health insurance coverage plays a crucial role in the financial impact of healthcare. While 43% of adults with employer-sponsored insurance reported difficulties affording healthcare, this figure rises to 57% for those on Affordable Care Act plans and 45% for Medicaid recipients. Furthermore, individuals with employer-based coverage were less likely to face financial challenges (21.6%) compared to those with other types of insurance, such as private non-group insurance (38.5%) and public coverage (over 50%).

  3. Implications for Healthcare Reforms: The findings underscore the urgent need for reform in healthcare billing, coverage, and debt management. The study, focusing on households with members under 65, shows that over 45% of participants faced healthcare challenges broadly defined, including delayed care and high out-of-pocket costs. This situation is particularly dire for the poorest adults, with incomes below 100% of the federal poverty level, who report financial strains more frequently. The widespread nature of these financial difficulties across different income and coverage groups provides critical context for ongoing healthcare reforms.

Balancing act: Managing mental health accommodations post-pandemic

By HRD - Mental health continues to be a paramount concern for employers post-pandemic, with more and more people succumbing to stress, burnout and feelings of isolation. Data from Forbes found that  92% of employees experience mental health challenges that impact their work, with 80% of workers adding that an organization’s mental health support is a key consideration when considering a new role. Read Full Article…

VBA Article Summary

  1. Recognizing and Addressing Stigma and Fear Surrounding Mental Health in the Workplace: Navid Kanani highlights the pervasive stigma associated with mental health, contributing to employees' reluctance in disclosing mental health issues. The fear of being unsupported or labeled as an outcast discourages open communication. Companies need to actively address these fears by creating an environment where mental health discussions are normalized and supported. This involves educating employees about their rights and the protections they have, reducing the fear of negative repercussions from disclosing mental health concerns.

  2. Legal Obligations and the Role of Education in Employee Well-being: Employers have a legal responsibility to educate their employees about their rights regarding mental health and disability protections. Kanani emphasizes the importance of this education, noting that unawareness of legal protections can further fuel employees' fears. For instance, in California, employers are required to inform employees about their disability protections, typically through posters. This step is crucial in creating a transparent environment where employees are aware of their rights and the support available to them, thus encouraging them to seek help when needed.

  3. Implementing Supportive Measures and Policies for Mental Health: To foster a more supportive workplace, Kanani suggests practical measures like mental health days and spa days, especially in high-stress environments like his litigation office. Additionally, he underscores the necessity of an open-door policy where employees can freely discuss their mental well-being with HR representatives or management. Such policies should be accompanied by a supportive and receptive approach, rather than an immediate problem-solving one. Moreover, employers have a legal duty to engage with employees who disclose mental or emotional disabilities and collaborate to find effective solutions, further emphasizing the need for proactive and supportive workplace mental health strategies.

House lawmakers launch probe into FDA's response to nationwide drug shortages

By Fraiser Kansteiner - As shortages of drugs like amoxicillin, penicillin, Adderall and certain chemotherapies continue to confound doctors and patients in the U.S., two high-ranking Republican lawmakers are pressing the FDA for answers. Read Full Article…

VBA Article Summary

  1. Congressional Inquiry into FDA Drug Shortage Mitigation Efforts: House Committee leaders James Comer and Lisa McClain have formally requested information and a briefing from the FDA to scrutinize the agency's strategies for mitigating drug shortages. Highlighting that these shortages are a chronic issue predating the pandemic, they express concerns about the FDA's ability to keep essential drugs available, as evidenced by the current list of 128 drugs in short supply, treating critical conditions such as infections and cancer.

  2. Causes of Drug Shortages and Proposed Solutions: The legislators identify several factors contributing to the drug shortages, including an over-reliance on foreign drug manufacturing, increased demand, and reduced production of generic drugs. They advocate for increased domestic manufacturing to alleviate shortages, citing a statistic that 70% of drug manufacturing facilities for the U.S. market were overseas in 2022, which they argue presents risks and insufficient FDA oversight.

  3. Industry and FDA Perspectives on Drug Supply Issues: FDA Commissioner Robert Califf has acknowledged a divide in the pharmaceutical industry between high-priced branded drugs and low-priced generics, which affects supply dynamics. Meanwhile, FDA officials point out the agency's limited authority in compelling drug manufacturing or managing demand spikes. The industry's lack of investment in production capacity is seen as a primary cause for ongoing shortages, highlighting the complex nature of the issue that extends beyond the FDA's regulatory scope.

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CMS extends Medicare Telehealth Reimbursement Waiver through 2024

By Eric Wicklund - A key Medicare reimbursement for health systems the deploy telehealth services has been extended through the end of 2024, along with a measure that gives physicians who work from home some privacy and security. Read Full Article…

VBA Article Summary

  1. Enhanced Medicare Reimbursement for Virtual Care: The CY 2024 Medicare Physician Fee Schedule (PFS) includes a significant update that allows healthcare providers to be reimbursed by Medicare for delivering virtual care services from their homes. This change is aimed at enhancing the efficiency and accessibility of telehealth services, catering to both patient needs and provider convenience. This decision reflects a growing recognition of the importance of telehealth in modern healthcare, particularly in the context of ongoing healthcare provider shortages and burnout issues.

  2. Privacy and Safety for Healthcare Providers: A critical aspect of this new rule is the provision that allows providers to avoid listing their home address as a practice location. This development is a response to concerns about the safety and privacy of healthcare providers, who have increasingly faced threats from various groups and individuals. The American Telemedicine Association (ATA) and other healthcare organizations have advocated for this change, emphasizing the importance of protecting healthcare providers from potential harassment or danger that could arise from publicly listing their home addresses.

  3. Setting the Stage for Telehealth Advancements in 2024: Kyle Zebley of the ATA highlights the implications of these changes for the future of telehealth, anticipating a significant evolution in healthcare delivery by the end of 2024. With the extension of pandemic-era waivers and the new provisions in the Medicare PFS, there is an expectation of transformative changes in telehealth policies and practices. These changes not only cater to current healthcare challenges but also pave the way for more sustainable and patient-centric healthcare models. This shift is seen as an opportunity to innovate and improve healthcare delivery, particularly in a post-pandemic world.

Why DEA’s latest move on telehealth could be a lifesaver

By Tanya Albert Henry - Physicians can continue to prescribe controlled substances based on telehealth patient visits after the Drug Enforcement Administration (DEA) extended this regulatory flexibility through Dec. 31, 2024. “The AMA is grateful the DEA recognizes patients being treated with these medications, including medication to treat opioid-use disorder, often have challenges securing and traveling to in-person appointments, and that the agency is committed to avoiding lapses in their care,” said AMA President Jesse M. Ehrenfeld, MD, MPH. Read Full Article…

VBA Article Summary

  1. Advocating for Sustainable Telehealth Policies: Dr. Ehrenfeld, in his engagement with the DEA, emphasized the need for federal policies that support the continued use of telehealth for prescribing controlled substances. He highlighted the importance of these policies in maintaining the advances in patient access to care that were achieved during the COVID-19 public health emergency. His advocacy aligns with the American Medical Association's (AMA) Recovery Plan for America's Physicians, underscoring telehealth as a critical component for future healthcare sustainability.

  2. Telemedicine's Proven Effectiveness in Treating Opioid Use Disorder: Evidence presented by Dr. Ehrenfeld from recent studies illustrates the significant impact of telemedicine in treating opioid use disorder. For instance, a study in JAMA Psychiatry showed a 33% reduction in the odds of a fatal overdose for patients treated via telehealth, compared to those who did not receive medication treatment. Another study highlighted how telemedicine facilitated quicker access to treatment for patients seeking buprenorphine, avoiding delays inherent in waiting for in-person evaluations. These findings underscore the necessity of integrating telehealth into the standard care for opioid use disorder and other medical conditions.

  3. Ensuring Patient Safety While Expanding Access: In his address to the DEA, Dr. Ehrenfeld stressed the importance of maintaining a balance between expanding patient access to care through various telehealth modalities and ensuring patient safety. He pointed out that existing safeguards like state laws and the Controlled Substances Act play a crucial role in preventing misuse and diversion of controlled substances. This perspective is critical as the AMA continues to advocate for policies that facilitate the prescription of controlled substances via telehealth, even in cases where a previous in-person visit has not occurred. This stance is further reinforced by support from various senators, recognizing the importance of telehealth in contemporary healthcare, especially in managing the ongoing opioid epidemic.

FDA investigating reports of hospitalizations after fake Ozempic

By Alexander Tin - At least three Americans have been reported hospitalized after using suspected counterfeits of semaglutide drugs, which include Novo Nordisk's diabetes medication Ozempic, according to records released by the Food and Drug Administration. Read Full Article…

VBA Article Summary

  1. Rising Concerns Over Counterfeit Semaglutide Products: Amid a shortage of Ozempic and Wegovy, two popular weight loss medications from Novo Nordisk, there has been a surge in counterfeit semaglutide products globally. The FDA and its counterparts like the UK's Medicines and Health Products Regulatory Agency have reported multiple instances of counterfeit drugs, including fake Ozempic pens. These counterfeits have been linked to several serious adverse events, including hospitalizations and even deaths, as reported to the FDA’s Adverse Event Reporting System.

  2. Identification and Regulation Challenges: The FDA, along with Novo Nordisk, is actively working to raise awareness and guide consumers on identifying counterfeit products. Novo Nordisk has released a press statement with tips for spotting fake products, as some counterfeits are sophisticated enough to mimic the packaging and labeling of genuine Ozempic pens. However, the distinction between real and counterfeit products is not always clear, and there is growing concern over semaglutide alternatives provided by drug compounders, which are not under the same rigorous FDA oversight as the approved medications.

  3. Ongoing Investigations and Regulatory Response: The FDA is investigating the surge in counterfeit semaglutide products and has pledged to determine the public health risks and appropriate regulatory responses. This investigation includes tracking down counterfeit pens entering U.S. pharmacies and increasing scrutiny of compounded drug products during the shortage. The agency has also communicated with pharmacy boards about the rising number of adverse events and complaints related to these compounded products, highlighting the broader challenge of ensuring drug safety and authenticity during medication shortages.

To truly unleash the power of generative AI, don’t forget the human

By Jason Averbook - In the world of HR and HR technology, it’s hard to have a conversation without the topic of generative AI coming up. This form of technology can create everything from intricate designs to engaging written content. It’s truly changing what we believe is possible when it comes to leveraging technology. Read Full Article…

VBA Article Summary

  1. Divergence in Pace Between Technology and Human Adaptation: Technology evolves rapidly due to its inherent nature of pursuing efficiency, fueled by continuous innovation, competition, and evolving consumer demands. In contrast, humans are creatures of habit, necessitating time to adjust to technological changes. This disparity explains why the workplace often feels outdated compared to the outside world. While technology leaps forward with every new development aimed at efficiency, humans require gradual adaptation, involving changes in thinking, working, and interacting with these advancements.

  2. Bridging the Gap through Human-Centric Technology: The key to minimizing the gap between technological advancement and human adaptability lies in focusing on technologies that enhance, rather than replace, human capabilities. For example, generative AI should be utilized not merely for task completion but to augment human intelligence, foster continuous learning, and adapt more fluidly to changes. This approach not only helps keep pace with technological advancements but also reimagines a culture where technology is leveraged to enhance human potential and unlock new opportunities.

  3. Emphasizing the Human Element in Technological Implementation: The true value of technology is realized when it is aligned with human needs and potential. This is evident in examples like online shopping experiences, where companies like Amazon and eBay use advanced technologies not just for transactions, but to understand and build relationships with consumers. Similarly, in the workplace, technology should be employed not merely as a tool but as a system that enhances human potential, ensuring that the focus remains on creating value for and through people. This human-centered approach in using technology like generative AI is crucial for achieving a balanced progress where technology and human adaptability advance in unison, ensuring that no one is left behind in the journey towards the future.

A quarter of US medical students consider quitting school and most may not treat patients: new survey

By Shiv Sudhakar - Among the next generation of doctors, many are considering quitting medical school even before donning their long white coats. A quarter of all medical students in the United States might quit school. That’s according to a new report from Elsevier Health, which surveyed students to get their perspectives on education, career plans and expectations for the future of health care. Read Full Article…

VBA Article Summary

  1. High Levels of Stress and Burnout Among Medical Students: The Clinician of the Future program, initiated by Elsevier Health, reveals concerning trends among medical students globally. According to their survey, a significant number of students are considering abandoning their medical education due to overwhelming stress and burnout. Experts like Dr. Jonathan Ripp and Dr. Martin Rubin emphasize that the increasing demands of medical education, including learning basic medicine, conducting research, and understanding cultural competency, are exerting excessive pressure on students.

  2. Impact on Future Career Choices and Mental Health: The survey highlights a worrying shift in career preferences among medical students. About 58% of those continuing their medical education are contemplating careers outside of direct patient care. Furthermore, 54% express concerns about the mental health impact of a medical or nursing career. These statistics are alarming, considering the pre-existing evidence of high distress and mental health issues in the medical profession.

  3. Responses and Measures to Address the Issue: Despite these challenges, not all students are deterred from pursuing their medical careers. Some find their passion in specialties like surgery, which rekindles their excitement and commitment to the profession. Medical education authorities and institutions are increasingly aware of these issues, leading to the introduction of wellness leaders and integration of well-being topics into medical curricula. Organizations like the CDC and AAMC are actively working to improve the mental health and well-being of medical students, indicating a positive trend towards addressing these critical issues.