Daily Insurance Report - October 19, 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

What was your experience this year related to the cost of your health plan renewal?

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Our last poll results are in!


of Daily Insurance Report readers who responded to our last poll stated that Financial Wellness is a primary focus for their 2024 benefit initiatives.

25.76% are focused on Mental Health, 16.67% are focused on Medical Gap, and 8.33% are focused on Identity Theft / Cyber Security, while 18.18% are focused on “other” types of programs for their 2024 benefit initiatives.

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Aneesh Chopra: Risk-Based Contracting Is Succeeding—Right Now

By Mark Hagland - Aneesh Chopra served as Assistant to the President and Chief Technology Officer in the Executive Office of the President in the White House of President Barack Obama, from May 2009 through February 2012, helping to develop policy around technology and to guide thought leadership around technology. Read Full Article…

VBA Article Summary

  1. State of Value-Based Care: The current landscape of Alternative Payment Models (APMs) is at a pivotal moment in the U.S. healthcare system. There has been consistent improvement in the MSSP (Medicare Shared Savings Program) performance, and ACO REACH is showcasing potential expansion possibilities. However, while these programs have seen significant provider participation, a majority still haven't enrolled. The industry is now approaching a convergence, wherein the principles of value-based care are ready to be integrated into employer-sponsored operations, potentially revolutionizing the traditional payment structures.

  2. Progress of Value-Based Care Participation: When discussing organizations participating in MSSP, approximately 25-30% of primary care doctors treat patients in some form of an ACO model. The total numbers of lives enrolled in value-based programs like MSSP, REACH, and Primary Care First are significant, indicating a steady shift towards these models. Though many still perceive this as a minority, the infrastructure is in place for value-based care to take a more institutional role in healthcare.

  3. Impact of AI on Healthcare: The advent of generative AI, especially with models like ChatGPT, has revolutionized productivity across industries, including healthcare. This shift in AI capabilities has the potential to solve the longstanding computer investment productivity paradox in the healthcare sector. However, with these advancements come concerns about AI's risks. To safely harness AI's power, there's a need for a balance between industry guidelines and fostering experimentation. This multi-stakeholder, collaborative effort will be vital for the C-suite leaders in health systems, especially in the era of data interoperability, to navigate and adapt effectively.

Benchmark Survey: Annual Family Premiums for Employer Coverage Rise 7% to Nearly $24,000 in 2023; Workers Contribute $6,575 on Average Now, But Potentially More Soon

By KFF - Amid rising inflation, annual family premiums for employer-sponsored health insurance climbed 7% on average this year to reach $23,968, a sharp departure from virtually no growth in premiums last year, the 2023 benchmark KFF Employer Health Benefits Survey finds. Read Full Article…

VBA Article Summary

  1. Rising Health Care Costs and Premiums: On average, workers contribute $6,575 towards the cost of family premium in 2023, a $500 increase from 2022. Employers cover the remaining cost. Employees at smaller firms (fewer than 200 workers) generally contribute more towards family premiums compared to those at larger companies. Premiums have risen by 7% this year, mirroring the rate of increase in wages (5.2%) and inflation (5.8%). Over the past five years, there has been a 22% rise in premiums.

  2. Deductibles and Employer Concerns: The average deductible for single coverage is $1,735 in 2023, marking a 10% increase over five years and 53% over a decade. Employees at smaller firms face larger average deductibles than those at larger companies. 58% of employers express concern over the affordability of their plan’s cost-sharing requirements for their employees.

  3. Coverage and Services Variety: Post the Supreme Court’s decision in June 2022, 10% of large firms do not cover legal abortions at all, while 32% cover in most or all circumstances. Concerns exist about the adequacy of networks for mental health and substance use conditions among large employers. Other findings detail varying coverage options, including dental and vision insurance, gender-affirming surgeries, and "center of excellence" programs for specialized services.

Now Focus On Human Needs Because Employee Engagement Has Failed

By Liz Kislik - According to Gallup and other human resource-oriented surveys, employee engagement scores haven’t changed significantly in two decades, and if anything, they’re heading in the wrong direction. That makes sense, says Dan Pontefract, leadership strategist and author of Work-Life Bloom: How to Nurture a Team That Flourishes, because businesses are trying to evaluate the wrong thing. Read Full Article…

VBA Article Summary

  1. The Flawed Emphasis on Employee Engagement: Pontefract suggests that measuring employee engagement creates unrealistic expectations, as humans, much like gardens, undergo varying phases of growth and stagnation. The continuous push for constant engagement overlooks the natural ebb and flow of human energy and motivation. Corporate metrics, like an employee engagement survey showing only 38% engagement, are ineffective as they don't accurately reflect the well-being of individuals and can lead to negative sentiments among employees.

  2. Rethinking 100% Engagement: Leaders should recognize the inevitability of change in their employees' lives and the subsequent shifts in their engagement levels. Instead of concentrating on a strict numeric target for engagement, there should be a more human-centered approach. Leaders should regularly engage in open dialogues with their teams to understand their feelings and concerns. By addressing individual needs, such as those of a new parent who might feel out of place in a team without other parents, leaders can foster a supportive environment and promote genuine engagement.

  3. Team-Level Attention for Genuine Growth: For effective employee nurturing, the focus should be shifted to the small-group or team level. Leaders, by getting to know their employees intimately, can positively influence the 12 vital work and life factors essential for an individual's growth and satisfaction, including trust, belonging, relationships, and respect. This personalized attention not only results in happier and less stressed employees but also brings about higher customer satisfaction. Additionally, fostering "platonic life skills", such as financial literacy and relationship-building, can aid in the holistic development of an individual, fulfilling the true essence of work-life balance.

Some health care legislation could pass Congress despite leadership turmoil

By Susan Rupe - The leadership turmoil in the U.S. House of Representatives has clouded the outlook for passing health care legislation this year. However, there’s also a lot of momentum in Congress behind the health policy work that already has been done, so some health care reforms “have a chance of hitching a ride on a big catch-all bill at the end of the year. And legislation that doesn’t cross the finish line this year will carry over to next year.” Read Full Article…

VBA Article Summary

  1. Drug Pricing Reform: Geoff Manville highlights bipartisan support for drug pricing reform legislation in Congress. Two significant bills, HR 5378 and S. 1339, are targeting pharmacy benefit managers in the commercial market, aiming to reduce costs through enhanced transparency, increased provider competition, and billing reforms. Notable aspects of these bills include requiring new disclosures by PBMs, obliging PBMs to pass through all rebates and discounts to health plans, banning "spread pricing", and strengthening overall price transparency rules.

  2. Health Savings Account (HSA) Revisions: The House Ways and Means Committee has advanced two bills that update HSA rules which could be integrated into the end-of-year legislative bundle. The Bipartisan HSA Improvement Act (HR 5688) would permit individuals to convert their healthcare flexible spending or health reimbursement arrangement dollars into HSAs within specified restrictions. The HSA Modernization Act (HR 5687) proposes increasing the yearly HSA contribution limits, making provisions for HSA-eligible spouses aged 55+ to contribute to the same HSA, and enabling the utilization of HSA funds for specific long-term care services for the chronically ill.

  3. Retirement Policy and DC Plans: Manville draws attention to the ongoing agenda in Capitol Hill surrounding SECURE 2.0 and policies concerning defined contribution plan investments. While retirement policy seems to be transitioning more towards the regulatory sphere, work on the SECURE 2.0 technical corrections bill is ongoing, albeit with uncertain timing. Several bills aim to influence the future of retirement policy, such as the Auto-Reenroll Act, which encourages the adoption of automatic re-enrollment in retirement savings plans, and the Women’s Retirement Protection Act, which proposes spousal consent for DC plan distributions.

5 benefit challenges to tackle this open enrollment

By Lee Hefner - Benefits leaders have their work cut out for them when it comes to putting together the most impactful offerings. Only six in 10 employees are satisfied with their benefits — the lowest rate in a decade, according to MetLife. Seeking to examine things from an HR perspective, new and exclusive research from Arizent, EBN's parent company, found that a mere 30% of HR leaders believe their company does a good job of improving benefits utilization, and sheds light on what all survey respondents plan to do to improve the state of benefits within their organization. Read Full Article…

VBA Article Summary

  1. Expanding Supplemental Benefits Beyond Healthcare: Over half of benefits leaders aim to emphasize supplemental benefits more than core benefits. A majority wants to broaden offerings in healthcare, financial wellness, and personal growth. The objective is to cater to a diverse workforce, which is a primary goal for 30% of the respondents.

  2. Prioritizing Preventive Care: 36% of employers ranked the use of preventive and chronic illness management programs as a top-three priority. 40% of HR leaders plan to incorporate prevention and wellness offerings in the coming cycle. There's a focus on virtual care, in-office screening, vaccinations, and incentive programs to encourage employee participation.

  3. Enhancing Communication and Guidance: 44% of benefits leaders see "improving benefits communication" as a crucial priority, using various methods like emails, benefits portals, printed materials, and more. There's a significant reliance on brokers for guidance, with 84% using materials from benefits brokers or advisers to boost employee education. 63% provide or plan to offer employees direct access to a benefits advisor for detailed queries.

  4. Cost-Efficiency in Benefits - The top priority for benefits leaders in the next 12-18 months is finding ways to save costs on benefits. - Only 20% felt they saved effectively in their latest enrollment due to limited resources for making informed, cost-effective decisions.

Telehealth primary care visits boost in-person follow up

By John Commins - In-person follow-up visits were a bit higher after telemedicine consultations when compared with in-person primary care visits, but that varied by specific clinical condition, according to a study published today in Annals of Internal Medicine. Read Full Article…

VBA Article Summary

  1. Background and Methodology of the Study: This research was conducted by clinicians at Kaiser Permanente in Oakland, CA, and primarily funded by the Agency for Healthcare Research and Quality. It aimed to gauge the effectiveness of telemedicine in addressing patient needs following the COVID-19 public health emergency. The research spanned from April 2021 to December 2021, coinciding with the Delta wave of the COVID-19 pandemic. Within a vast integrated health care delivery system encompassing over 1,300 primary care providers, the study analyzed electronic health records of more than 1.5 million adult patients. These patients varied in terms of age, gender, ethnicity, socio-economic background, and health conditions, ensuring a diverse sample for analysis.

  2. Key Findings on Telemedicine Usage and Follow-ups: Of the 2.3 million primary care visits during the study period, telemedicine was utilized for 51% of these, with 19.5% being video consultations and 31.3% via telephone. Prescriptions were issued in 47% of in-person visits, 38% of video consultations, and 34.6% of telephone consultations. The rate of patients returning for an in-person visit within a week was noticeably higher for teleconsultations compared to in-person visits. Specifically, 1.3% of in-person consultations, 6.2% of video consultations, and 7.6% of telephone consultations resulted in a return in-person visit within 7 days. Furthermore, a smaller percentage of all visit types led to an emergency department visit within a week.

  3. Treatment, Outcomes, and Limitations: Treatment methods during the visits mainly consisted of prescribing medications or antibiotics, and ordering laboratory or imaging tests. Any follow-up within a week, whether to the primary care office, emergency department, or resulting in hospitalization, was also noted. To provide more accurate insights, outcomes were adjusted based on various sociodemographic and clinical characteristics. They were also segmented by clinical area, such as abdominal pain, musculoskeletal pain, routine care, hypertensionsion, diabetes, and mental health. It's vital to note the study's setting: telemedicine was fully integrated with the ongoing EHRs and the clinicians. The research also focused on an insured population during the late stages of the COVID-19 pandemic. However, the observational comparison lacked in-depth measures of symptom severity. Also, follow-up was restricted to a short 7-day period, and clinical area categorization depended on diagnosis codes instead of symptoms.

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NCPA launches company to assist pharmacies with litigation against PBMs over DIR fees

By Paige Minemyer - The National Community Pharmacists Association (NCPA) has launched the latest salvo in its battle with pharmacy benefit managers over controversial fees. Read Full Article…

VBA Article Summary

  1. Establishment of Trust LLC: The NCPA is launching Trust LLC, a limited liability company specifically designed to investigate the application of direct and indirect remuneration (DIR) fees by PBMs against community pharmacies. If deemed necessary, Trust will take legal or arbitration actions on behalf of these pharmacies.

  2. Antitrust Allegations: NCPA asserts that DIR fees represent an antitrust violation. They believe these fees have unjustly stripped community pharmacies of significant funds. The NCPA's CEO, B. Douglas Hoey, emphasized that the manner in which PBMs levy DIR fees against rival pharmacies compromises patient care and is detrimentally anti-competitive. This announcement follows closely on the heels of a lawsuit filed by an Iowa pharmacy against CVS Caremark, a major PBM, regarding DIR fees.

  3. Legal Representation and Collective Effort: Trust LLC has engaged three prominent law firms, including Berger Montague, Cohen & Gresser LLP, and Baker Donelson, to oversee potential litigation. It's highlighted that two of these firms are leading a class-action lawsuit against Caremark. Due to the immense resources of major PBMs, individual independent pharmacies often face insurmountable odds when confronting them. However, NCPA is enabling these pharmacies to consolidate their claims under Trust LLC, uniting them in their battle against the PBMs.

Might ChatGPT Transform Healthcare? Pioneering Leaders Are Working Forward to Find Out

By Mark Hagland - Perhaps no other phenomenon in U.S. healthcare has been the subject of a greater amount of hype, expectation, and confusion, all mixed up together, than has the emergence of artificial intelligence (AI). Read Full Article…

VBA Article Summary

  1. Evolution of AI in Healthcare: The article describes the current state of artificial intelligence (AI) in healthcare by referencing the Gartner hype cycle. The development of AI for clinical and clinical-operational uses is debated to be between the “Peak of Inflated Expectations,” the “Trough of Disillusionment,” or the “Slope of Enlightenment.” The introduction of ChatGPT by OpenAI has added another layer of complexity to this landscape, intensifying debates around the role of AI in healthcare.

  2. Real-world Application: ChatGPT in Patient Communication Triage: The University of Rochester Medical Center is highlighted as an example of how AI can be effectively implemented in healthcare. Michael Hasselberg, the chief digital health officer, shares the challenge they faced with MyChart messages, where they didn’t have an efficient system to triage incoming messages. They leveraged ChatGPT, tuning it to help triage these messages effectively. Within two days, the system demonstrated a reliability rate in the high 90s and an accuracy rate of around 85%. This rapid progress and success have shifted Hasselberg's view, making him optimistic about the potential impact of AI on healthcare.

  3. Expert Opinions and Future Implications: Several experts weigh in on the potential of AI in healthcare. While there is excitement, there is also caution, emphasizing the need to address concerns around trust, bias, and responsibility. Aaron Neinstein from Notable Health underlines that AI shouldn’t just be about big breakthroughs but also about alleviating the daily burdens faced by healthcare workers. He and other experts, such as Mathaeus Dejori and Ryan Nellis from PINC AITM Stanson Health, agree on the need for careful integration of AI technologies into clinical workflows, which requires tight integration of technology with operations. Hasselberg emphasizes the need for AI governance within health systems, while Nellis encourages health IT leaders to focus on important business opportunities and be realistic about their goals. Despite challenges, there is a consensus that AI presents significant opportunities for transforming healthcare in the near future.