Daily Insurance Report - October 20, 2023
📣 Calling All Licensed Insurance Professionals 📣
Earn 3.00 CE’s + Network at Atlantic City’s Ocean Casino Resort for FREE.
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:
Understanding the Dynamic Federal Employee Benefits Legislative Landscape
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.
How to rebuild trust in science: NIH director nominee fields questions
By Max Kozlov - Monica Bertagnolli, US President Joe Biden’s pick to lead the National Institutes of Health (NIH), hinted today during a long-awaited Senate committee hearing at what her priorities will be for the biomedical agency if she is confirmed. At the top of the list is improving the diversity of clinical-trial participants, enhancing collaboration among the NIH’s 27 institutes and centres and restoring public trust in scientists and the agency. Read Full Article…
VBA Article Summary
NIH's Changing Political Landscape and Bertagnolli's Confirmation: The National Institutes of Health (NIH), once enjoying bipartisan support and yearly budget increases, faced increased political scrutiny following the COVID-19 pandemic. This has raised concerns about the challenges that Monica Bertagnolli might encounter as its director. Bertagnolli, currently the head of the US National Cancer Institute (NCI), was nominated by President Biden to lead the NIH in May 2023. However, her confirmation hearing was delayed by Senator Bernie Sanders until an agreement to reduce US prescription-drug prices was in place. Despite bipartisan admiration for Bertagnolli's qualifications, senators pressed her on several controversial issues, highlighting the political challenges the NIH currently faces. In contrast, the previous NIH director, Francis Collins, was appointed with unanimous Senate support and no confirmation hearing in 2009.
The Controversy Surrounding NIH During COVID-19: Some Republican lawmakers made unverified claims that the NIH’s funding of coronavirus research in China could have been a factor in the global COVID-19 outbreak. This led to hearings in the US House of Representatives about the origins of the virus, putting figures like Collins and Dr. Anthony Fauci under scrutiny. Senator Bill Cassidy commented on how the pandemic has turned the NIH into a "lightning rod" for political debates, eroding public trust in the agency. As the potential new director, Bertagnolli would be expected to mend this fractured relationship with Congress and the public.
Bertagnolli's Trailblazing Career and Support from the Scientific Community: Monica Bertagnolli is recognized as the first female director of the NCI. If confirmed for the NIH role, she would become its second permanent female director. With a background as a cancer surgeon, she also led the surgical-oncology division at the Dana–Farber Cancer Institute in Boston as its first female head. Over 120 non-profit organizations, representing a diverse range of scientists, patients, and institutions, expressed their support for Bertagnolli's confirmation in a letter to Senate leaders, emphasizing the faith the scientific community has in her capabilities.
Healthcare worker exodus continued through 2022, new data shows
By Susanna Vogel - Provider quits varied by role, specialty and geography, according to the report’s analysis. The high quit rates of physicians and nurse practitioners could be due to their proximity to the COVID-19 pandemic, the report said. Read Full Article…
VBA Article Summary
Healthcare Staffing Crisis: Over 145,000 healthcare providers, including physicians and nurse practitioners, left the industry between 2021 and 2022. This significant attrition rate was driven in part by pandemic-related pressures such as fear of infection, excessive working hours, and mental health challenges. Staffing shortages, particularly pronounced in states like South Carolina, Maryland, and Virginia, have the potential to diminish the quality of care and lead to increased medical errors. A study highlighted that 34% of doctors globally noticed a rise in medical mistakes when understaffed. Certain specialties, like optometry and obstetrics, saw professionals exit due to challenges transitioning to telehealth and loss of revenue from reduced in-person visits during the pandemic's peak.
Economic and Emotional Toll: Burnout has been a long-standing concern in the healthcare sector, costing approximately $4.6 billion in 2019 due to turnover and reduced productivity. The recent surge in burnout levels can be attributed to increased workloads from staffing gaps, poor work-life balance, and administrative burdens. Particularly affected areas, such as rural hospitals, faced service suspensions owing to nurse staffing issues, highlighting the severity and breadth of the problem.
Potential Solutions and Concerns: To address the staffing crisis and its ramifications, some healthcare facilities are considering consolidation, aiming to decrease overhead and labor costs. However, research from Elevance Health suggests that hospital mergers may lead to reduced quality of care, increased insurance prices, and higher readmission rates for patients. The Definitive Healthcare report emphasizes the importance of investing in telehealth solutions. This can enable providers to attend to less severe cases virtually, thus reducing facility operating costs and potentially lowering readmission rates.
Kaiser Permanente agrees to $200M settlement after investigation reveals 'several' behavioral care deficiencies
By Dave Muoio - Kaiser Permanente’s insurer arm has agreed to a $200 million settlement over “deficiencies in the plan’s delivery and oversight of behavioral healthcare” to its members, the California Department of Managed Health Care (DMHC) announced last week. Read Full Article…
VBA Article Summary
Settlement and Investment in Behavioral Health: Kaiser Permanente, the largest healthcare service plan in California, has committed $150 million over five years to enhance its behavioral health delivery in the state. This comes after a settlement agreement and will involve the engagement of an external consultant to guide other improvements. $50 million of this amount comprises penalties, with $40 million payable to the state by October 21. An additional $10 million will be due if the Department of Managed Health Care (DMHC) determines that Kaiser did not reasonably fulfill its settlement obligations.
DMHC's Investigation into Kaiser's Behavioral Health Operations: The DMHC's decision to conduct a non-standard review of Kaiser's behavioral health operations was influenced by complaints from enrollees, providers, and other stakeholders. Factors such as a strike involving 2,000 behavioral health clinicians and the COVID-19 pandemic magnified the challenges faced by Kaiser. The DMHC's investigation unveiled deficiencies in various areas, including quality assurance, timely access to care, and communication. The settlement necessitates improvements across these domains.
Statements from Key Stakeholders: California Governor Gavin Newsom stated that this settlement is a significant move towards enhancing accountability in the delivery of behavioral health services, emphasizing the importance of private sector responsibility. DMHC Director Mary Watanabe highlighted the department's commitment to ensuring enrollees receive the necessary behavioral health care. Meanwhile, Kaiser Permanente CEO, Greg Adams, acknowledged the increased demand for mental healthcare services during the pandemic, which surged by 33% for Kaiser. He admitted that during the DMHC survey, the organization did not meet the expectations of its members.
October 2023 Health Sector Economic Indicators Briefs
By Altarum - Altarum's monthly Health Sector Economic Indicators (HSEI) briefs analyze the most recent data available on health sector spending, prices, employment, and utilization. Support for this work is provided by a grant from the Robert Wood Johnson Foundation. Below are highlights from the October 2023 briefs. Read Full Article…
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Revised Health Spending Data for 2022-2023: In August 2023, national health spending saw an increase of 5.4% year over year, accounting for 17.2% of the GDP. Despite this rise, nominal GDP growth in August 2023 (5.6% year over year) was slightly faster than health spending. Spending on personal health care increased by 7.4% year over year in August when government subsidies were excluded, and by 6.8% when they were considered, surpassing the GDP growth rate for seven months in a row. Among major categories, prescription drug spending witnessed the highest year-over-year growth in August (10.8%). The reported changes in health spending are a result of the Bureau of Economic Analysis' 2023 Comprehensive Update to the National Economic Accounts, which led to revisions in health spending data for both 2022 and 2023.
Stability in Health Care Price Growth and Inflation: The Health Care Price Index (HCPI) remained steady at 2.8% year over year in September, consistent with the growth in August. Meanwhile, economywide inflation, as measured by the Consumer Price Index (CPI) and the Produce Price Index (PPI), remained moderate. Among various health care categories, home health care, nursing home care, and dental care witnessed the most significant price growths. Conversely, physician and clinical services recorded the slowest price growth. Health care service prices for Medicaid patients increased by 4.2% year over year in September, surpassing that of private insurance and Medicare patients.
Trends in Health Sector Employment and Wages: After robust job growth in the health sector during July and August 2023, September saw a deceleration with 40,900 jobs added. Ambulatory care settings led this growth, with hospitals and nursing and residential care facilities also contributing. The broader economy added a substantial 295,100 jobs in September, and the unemployment rate remained unchanged at 3.8%. Health care wage growth in August 2023 stood at 3.4% year over year, which is somewhat less than the total private sector wage growth. Within the health care sector, nursing and residential care witnessed the highest wage growth, followed by hospitals and ambulatory care settings.
Research shows an increase in ‘strategic’ HR leaders. Here’s where they are focused
By Jill Barth - Strategic organizations rely on a culture built around data, according to leading industry analyst Stacey Harris. HR leaders, in particular, need to anchor their work in data, as they are increasingly looked to as strategic partners, according to the results of the highly anticipated HR Systems Survey. Read Full Article…
VBA Article Summary
The Role of Strategic HR: Sapient Insights Group's research presented by Stacey Harris underscores the importance of strategic HR in understanding how workforce decisions impact organizations at all levels. Strategic HR, distinct from transactional HR, not only aligns with the C-suite's goals but also significantly contributes to the organization's overall outcomes. Successful strategic HR teams emphasize adaptable change management, data-driven workforce planning, skills management, and strict adherence to technology ethics codes.
Key HR Data Insights:
Change Management - Harris stresses the need to manage change rather than merely implementing change management. Efficient change management can yield double-digit returns on HR tech investments.
Return-to-Office Trends - The shift towards hybrid workplaces is evident, with only a 9% increase in in-office work from 2022 to 2023. Organizations offering flexibility will likely attract top talent.
HR Tech Investment - An 11% decrease in plans to increase HR tech spending has been reported, with mid-market organizations experiencing the largest reductions.
Vendor Performance - HR tech vendors have shown a 14% increase in customization, a 3% rise in user experience, and vendor satisfaction. However, payroll is the one area showing decreased satisfaction.
Emerging HR Trends and Challenges:
Skills Management - Harris emphasizes the importance of creating a robust skills taxonomy that can show a return on investment. Specifically, there's a notable gap in HR tech skills, with 54% of professionals having less than three years of experience.
Artificial Intelligence in HR - As technology evolves in the HR sector, understanding AI's potential impact is essential. Harris stresses the importance of knowing the ethics of AI and the potential risks, especially since low-credibility HR departments are 70% more likely to lack an ethical strategy for AI use.
How to Rethink Protecting Against Cyberattacks
By Noah Zuss - Mitigating cybersecurity threats requires organizations to reassess their approach to technical vulnerability, advised an internet security expert and author at the “Cybersecurity Threats and Concerns: An Overview” session of PLANSPONSOR’s Cybersecurity livestream on October 12. Read Full Article…
VBA Article Summary
Rising Economic Impact of Cybercrime: By 2023, the economic repercussions from cybercrime will touch $2 trillion annually. This figure is expected to skyrocket to $10.5 trillion by 2025 as per the data provided by the Internet Security Alliance. The cost-effective nature of cybercrime tools available on the dark web, such as DDoS attacks for $500 and email attack tutorials for $25, emphasizes the vast discrepancy between the low investment of cybercriminals and the potentially colossal damage they can inflict.
Shift in Organizational Cybersecurity Mindset: Larry Clinton, president of the Internet Security Alliance, emphasizes a restructured approach to cybersecurity, advocating for a top-down perspective. This shift means that cybersecurity should not just be seen as an IT department's role but should permeate the entire organization's culture, starting from the board down to various departments. Clinton advises organizations to follow six core principles, which include viewing cybersecurity as a business strategy, aligning it with business needs, and incorporating cybersecurity expertise into board governance, among others.
Recommendations and Best Practices: Entities, including investment advisers and retirement plan members, should ensure cloud-stored data is secure, periodically train in cybersecurity awareness, encrypt sensitive data, and have robust business resiliency programs. In accordance with the Securities and Exchange Commission rules, it's crucial to embed cybersecurity in comprehensive risk evaluations, delegate specific roles and responsibilities regarding cybersecurity, regularly update security tools, and have a concrete plan in case of a cyberattack, including communication channels with authorities and clients.
Amazon Starts Delivering Medications via Drone
By Marissa Plescia - Amazon Pharmacy is working to speed up prescription medication delivery in College Station, Texas, through its free drone delivery service, the company announced Wednesday. With drones, Amazon said prescriptions can be delivered within 60 minutes. Read Full Article…
VBA Article Summary
Amazon Drone Delivery Service in College Station: Residents can schedule a free yard consultation, and if deemed suitable, Amazon provides a marker for drone deliveries. Eligible customers can select drone delivery for their medications at checkout, with over 500 medications available for conditions like flu, asthma, and pneumonia. Dr. Vin Gupta, Amazon Pharmacy’s chief medical officer, emphasizes the importance of timely treatment, highlighting the challenges of obtaining medications promptly.
Drone Specifications and Advantages: Amazon’s drones operate between 40 to 120 meters altitude, using sensors and cameras to safely navigate around potential obstacles. Calsee Hendrickson from Prime Air points out the efficiency of drones, as they bypass traffic, ensuring faster delivery times. Customers indicated a desire for rapid drone delivery, especially for health-related purchases valuing speed and convenience.
Amazon’s Broader Healthcare Initiatives: Drone delivery for medications is part of Amazon Pharmacy's expansion plan. Other Amazon healthcare ventures include the Amazon Clinic, the acquisition of One Medical, and the introduction of RxPass. While Amazon has seen success in healthcare, it has also experienced failures, but Dr. Nworah Ayogu stresses that every initiative provides valuable learning experiences for the company's future growth in the sector.
A roadmap to build better benefits tech into your long-term strategy
By Luray Tobar - It seems like complexity is always increasing for HR leaders. In addition to everything that has historically been on their plate, they continue to face the ongoing challenges of employee retention and recruitment. And now, they find themselves responding to increased federal regulations for benefits reporting and transparency. Read Full Article…
VBA Article Summary
Analyzing Organizational Profiles for Benefit Technology: Employers who haven't implemented benefits technology face risks such as non-compliance, human error, and are limited to manual administration. Employers with underutilized or improperly integrated technology face employee disengagement, unrealized efficiencies, and costly manual errors. Dissatisfaction with current technology can lead to overburdened systems, a lack of strategic direction, and disengaged employees.
Choosing the Right Benefits Administration Solution: Conduct a needs analysis to identify inefficiencies, outdated systems, and areas for improvement. Opt for solutions that accommodate various benefit offerings, provide self-service tools, offer multiple channels of interaction (mobile, virtual assistance, human help), ensure easy access to information, and maintain compliance. Essential features to consider include an intuitive user interface, personalized functionalities, integration capabilities, comprehensive support, and cost-effectiveness in line with value.
Maintaining Value with Proper Support: A support plan is crucial as both requirements and technology change over time. Integrated systems need regular maintenance to adapt to a changing environment. Support extends beyond initial implementation; ongoing changes, testing, and different support levels for diverse workforces are essential. Ensure you have an expert consultant or technology provider and a benefits administration advocate for assistance and queries. Regularly conducting a needs analysis is vital, as outdated systems can lead to extra costs and liabilities. Staying updated with the industry and organizational changes ensures the effectiveness of the benefits program.
Column: Big drug makers are whining about having to negotiate with Medicare, but they can’t afford not to
By Michael Hiltzik - Given the pharmaceutical industry’s conviction that the government’s Medicare drug negotiation program will “deal a fatal blow” to its innovative research, “coerce” it into sacrificing its rightful profits, kill innocent patients and was also unconstitutional, naturally the companies would decline to participate. Read Full Article…
VBA Article Summary
Manufacturers' Involvement and Litigation Challenges: The White House has confirmed that manufacturers of all 10 drugs chosen for the negotiation process have agreed to participate. Out of these, eight companies are challenging the negotiation program through federal lawsuits. The companies include Merck, Johnson & Johnson, AstraZeneca, Novo Nordisk, Bristol Myers Squibb, Novartis, and Boehringer Ingelheim. Phrma, the pharmaceutical industry’s lobbying arm, filed a separate lawsuit. AbbVie, associated with another drug on the list, is specifically named in the U.S. Chamber of Commerce lawsuit, suggesting its direct interest in the case's outcome.
Negotiation Leverage and Manufacturers' Concerns: Drug manufacturers are participating in the negotiation process despite their legal challenges, showcasing the efficacy of the program's design. Medicare, the country's largest drug buyer, cannot back out of negotiations and is legally required to cover all FDA-approved drugs. The drug makers can only leave the negotiation by removing all their drugs from Medicare—a significant move. If manufacturers don't negotiate in good faith, they might face substantial excise taxes. These pharmaceutical companies argue that the rules infringe on their rights, terming them as coercive, unconstitutional, and other negative attributes. Their strategy appears to be participating in the program while simultaneously attempting to have it nullified in court.
Medicare's New Negotiation Power and its Impacts: As a part of the Inflation Reduction Act signed by President Biden in August 2022, Medicare was granted the power to negotiate drug prices with manufacturers. The act's goal is to reduce prescription drug prices, introducing measures such as requiring drug companies to pay rebates if they increase prices faster than inflation and capping out-of-pocket expenses. The negotiation program requires Medicare to choose specific branded, non-generic drugs based on their expenditure, with the first round including drugs like Xarelto and Eliquis. The negotiated prices should be 25% to 60% less than a drug’s average non-federal market price. The legal challenges from Big Pharma include concerns about the impact of the negotiation program on the development of "orphan" drugs, with some companies arguing that the program could deter the development of drugs for rare diseases.