Daily Insurance Report - October 25, 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.
Forget Fair-Weather Healthcare: Disruptors of This Industry Are Already in It
By Owen Tripp and Bob Kocher - A Formula 1 racing car is no joke. It’s purpose built, at great cost, at state of the art facilities with wind tunnels to improve aerodynamic performance and speed. The goal is simple: to win on tracks like the iconic Silverstone. It would be dangerously pointless to take an F1 car to the desert, smashing it through sand and into rocks, and expect it to perform the same. But today in healthcare, a host of new entrants and stakeholders is doing exactly that. Read Full Article…
VBA Article Summary
The Limitations of Outside Entrants: Companies from other industries are trying to transition their skills into healthcare, often touting AI and other technologies as revolutionary tools for the sector. While there are useful applications, these entrants tend to oversell the benefits without truly understanding the intricacies of healthcare. Well-established tech brands promoting AI as a major healthcare solution are primarily advocates of PR rather than tangible results. AI can aid certain processes but can't singularly reform the healthcare system.
Value of Specialized Healthcare Companies: Genuine innovation in healthcare comes from businesses designed specifically for the sector. Companies like Oak Street and Agilon, which focus on primary care, have been successfully integrating technology with human abilities, ensuring patients receive accurate insights tailored for them. Unlike external players, these companies possess credible data and experience. Their methods and strategies have been proven effective, especially during challenging times like Covid pandemic.
Healthcare Requires Deep Commitment and Nuance: For entities where healthcare is merely a subset of their operations, their approach often remains superficial, leading to inefficient strategies and outcomes. Traditional metrics from other industries can't be imposed on healthcare, as they don't align with the sector's unique requirements. Successful healthcare providers emphasize long-term results over short-term gains. Real changes in the healthcare landscape demand expertise, a comprehensive understanding of workflows, and a genuine commitment to improving both patient experiences and clinical outcomes.
Companies Cite Rising Costs of Living for Providing Financial Wellness Benefits
By Amanda Umpierrez - Employers are now pointing to high costs of living as the top reason for offering financial wellness initiatives, surpassing retirement preparedness for the first time ever, finds the sixth annual Financial Wellbeing Employer Survey from the Employee Benefit Research Institute (EBRI). Read Full Article…
VBA Article Summary
Drivers and Challenges of Financial Wellbeing Programs: A report from EBRI highlights the top five motives for financial wellbeing programs to include healthcare costs, budgeting, and daily living expenses. Productivity and employee satisfaction also featured as primary drivers. However, the cost implications for both employees and employers pose challenges. Craig Copeland, the director of Wealth Benefits Research at EBRI, emphasized that despite these challenges, most benefits decision-makers are optimistic about an increase in the budget for such programs in the near future.
Key Findings from the EBRI Report:
Measuring Success - A significant shift from 2022 has been observed where now, increased employee productivity and overall worker satisfaction are the top factors for measuring the success of financial wellness initiatives.
Cost-Benefit Analysis - 87% of companies have performed a cost-benefit analysis focusing on several factors like employee satisfaction and productivity. The leading factor for this analysis was employee satisfaction.
Impact on Mental Health - A whopping 85% of companies noted that financial wellbeing initiatives affect employees' mental, emotional, and social wellbeing. Additionally, 48% of them offer mental health benefits.
Caregiving Benefits - Most of these benefits revolve around leave policies, with 60% of employers offering flexible work arrangements.
Addressing Diversity - Companies are inclined to provide diverse financial solutions and counselors rather than tailoring messages specifically for diverse groups.
Understanding Diverse Needs - To cater to diverse workers, the most common step taken by companies is employee surveys.
Future of Financial Wellness Programs: As we approach 2024, the evolution of financial wellness programs remains pivotal, especially with the restarting of student loan payments for many employees. Jake Spiegel from EBRI notes that as these programs gain significance in terms of value to employees and as tools for attraction and retention, the anticipation and demand for these programs will continue to rise.
Health Systems Press CMS To Let Doctors Use Telehealth At Home
By Eric Wicklund - A key Medicare waiver that allows healthcare organizations to develop provider-friendly telehealth programs is set to expire at the end of the year, and advocates are lobbying federal officials to make it permanent. Read Full Article…
VBA Article Summary
Background and Telehealth Adoption During the Pandemic: Over 110 organizations, backed by the American Telemedicine Association and involving major health systems, have called on the Centers for Medicare & Medicaid Services (CMS) to perpetuate a pandemic waiver. This waiver permitted providers to bill Medicare for telehealth services they conducted from their homes. Before the pandemic, CMS did not offer clear guidance on how telehealth from a "distant site" should be billed, making many health systems hesitant to adopt telehealth services without guaranteed Medicare reimbursement.
Benefits and Importance of Telehealth from Home: The waiver has allowed health organizations to formulate programs that let their doctors operate from home, which not only ensures consistent, around-the-clock coverage but also reduces the overheads linked with in-house telehealth programs. Moreover, it has empowered health systems to implement policies that help in decreasing workplace stress and burnout among their staff, a crucial factor in attracting new doctors. The advocates highlight that practicing telehealth from home augments patient access to services, curtails healthcare expenditures, and aligns with the patient demand for care. This flexibility in providing care is deemed necessary, given the challenges of stress and burnout faced by 78% of healthcare practitioners.
Concerns and Recommendations: In their communication to CMS Administrator Chiquita Brooks-LaSure, the organizations emphasized the safety and privacy concerns of healthcare professionals. They advocated that practitioners shouldn't be compelled to reveal their home addresses due to the heightened risks they face, given the increasing violence against medical professionals during and after the pandemic. The letter puts forth two main recommendations: to make the waiver permanent, allowing telehealth billing from any location competent in offering in-person care, and to establish an alternative method for determining reimbursable telehealth service sites without mandating the reporting of a home address. They suggest using a business address for enrollment purposes and a geographic indicator for billing.
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
Organizational Profiles for Benefits Technology:
- Organizations that haven't adopted benefits technology due to perceived complexities, costs, or potential disruptions. This choice often leads to inefficiencies, non-compliance risks, human errors, and the limitations of manual administration.
- Those that have adopted technology but aren't maximizing its potential, either because it's not intuitive, properly configured, or fully integrated. Consequently, they face challenges like reduced employee engagement, unrealized efficiencies, and manual intervention errors.
- Entities that are unsatisfied with their current technology because it doesn't meet their needs, isn't well-supported, or isn't fully utilized. This can lead to disengaged employees, system overloads, manual processes, and a lack of clear strategic direction.
The Importance of a Needs Analysis: To ensure the effectiveness of a benefits program, organizations should first identify which of the three profiles they belong to. This can help consultants conduct a needs analysis to identify factors impacting the program. Outdated technology, labor-intensive methods, limited reporting, and costly delays are among the potential pitfalls. The ideal solution should offer a range of tools to execute a benefits strategy efficiently, drive employee engagement, and align with the organization's broader business objectives.
Key Features to Consider for Benefits Administration Solutions:
- A user-friendly interface with an intuitive design.
- Comprehensive features and functionalities, including tools for payroll deductions, communication, enrollment, compliance, billing, and eligibility management.
- Seamless integration capabilities, enabling connections to carriers, payroll, or HRIS.
- Robust support both during and post-implementation, including training, technical support, and user assistance.
- An appropriate cost-to-value ratio, ensuring a return on investment with the required features, flexibility, and a positive user experience.
Study: Some AI chatbots provide racist health info
By Maya Goldman - Some of the most high-profile artificial intelligence chatbots churned out responses that perpetuated false or debunked medical information about Black people, a new study found. Read Full Article…
VBA Article Summary
Lack of Oversight in Medical Chatbots: As the use of AI and chatbots in medicine grows rapidly, there is a conspicuous absence of regulation and oversight. This leaves room for these tools to inadvertently use and perpetuate inaccurate data. If these inaccuracies are based on debunked racial or ethnic beliefs, it can exacerbate health disparities. The recent study from Stanford University reveals that renowned AI models, including OpenAI's ChatGPT and Google's Bard, were found to use debunked race-based information when queried about specific medical functions. This raises concerns about the perpetuation of stereotypes and misinformation in medical chatbots.
Real-World Implications of Incorrect Data: The study underscores the tangible risks associated with AI models providing incorrect or biased information. Using race-based equations for kidney and lung functions, for instance, can lead to misdiagnosis or delayed care, especially for Black patients. Stanford University assistant professor Roxana Daneshjou emphasizes the severe consequences of these inaccuracies and highlights the need to remove such outdated notions from the realm of medicine.
Efforts to Address Biases: In light of the concerns raised, tech giants like Google and OpenAI have acknowledged the challenges and are actively striving to mitigate biases in their AI tools. Additionally, global organizations like the World Health Organization have previously emphasized the importance of ethical oversight for AI in medicine, pinpointing potential biases in training data as a significant concern. This collective acknowledgment and action from industry leaders signal the importance of rectifying these issues to ensure AI chatbots in medicine are both helpful and unbiased.
Employers interested in weight-loss solutions as new drugs become available
By Alan Goforth - The availability of an effective new class of medications to treat obesity raises a weighty question for employers. How do they balance promoting wellbeing in the workplace and potentially reducing insurance premiums with the prohibitively high cost of the new drugs? Read Full Article…
VBA Article Summary
Financial Impact of Workplace Obesity: Workplace obesity has considerable economic repercussions on businesses due to decreased productivity, heightened absenteeism, and escalated health issues leading to increased insurance costs. A substantial proportion of U.S. employers (22%) are now covering prescription drugs for weight reduction, 45% are funding bariatric surgery, and one-third have implemented some kind of weight management initiative, as cited by the International Foundation of Employee Benefit Plans.
The GLP-1 Weight-loss Medication Phenomenon: GLP-1 medications like Ozempic and Wegovy, initially prescribed for diabetes, are now being harnessed to combat obesity and excessive weight. While they are hailed by some as a "miracle weight-loss drug", the reactions from users are mixed. Many are eager for a prescription, while others are hesitant or averse to the regular injections that can cost up to $1,600 monthly. This rise in GLP-1 weight-loss drugs has caused uncertainty among employers, with 60% unsure of how the popularity of these drugs might reshape their workplace health programs, as noted in the 2023 Trends in Workplace Wellness Survey by EPIC Insurance Brokers & Consultants.
The Future of Wellness Programs and Integrated Solutions: In light of these challenges, there's an emerging interest in a comprehensive weight-loss strategy that encompasses both lifestyle changes and medication where suitable. Surveyed employers expressed significant interest in this integrated approach, demonstrating their commitment to devising benefits packages that prioritize employee wellbeing without exceeding budgetary constraints. As Erin Milliken of EPIC asserts, despite the ongoing challenges, employers are recognizing the crucial role they have in the holistic wellbeing of their staff. A shift in perspective, viewing wellness programs as instruments to foster community, uplift morale, and provide multifaceted support, is likely to bring about transformative outcomes in the future.
Medicaid expansion could cover more than 2M additional people
By Noah Tong - The uninsured population could drop by 25% in 10 states yet to expand Medicaid, an analysis from the left-leaning Urban Institute found with support from the Robert Wood Johnson Foundation. Read Full Article…
VBA Article Summary
Limited Medicaid Expansion: Currently, only 10 states, including Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming, have refrained from expanding Medicaid eligibility under the Affordable Care Act. By expanding, they would provide more than 2.3 million individuals with health coverage, thus reducing the national uninsured rate to less than 25%.
Major Impact on Southern States: Particularly in Mississippi and Alabama, the expansion of Medicaid to non-elderly adults earning up to 138% of the federal poverty line could significantly impact their uninsured populations, covering 39.4% and 37% respectively. The majority of the 10 non-expanding states could witness nearly a 20% decrease in their uninsured rates. By contrast, Wisconsin would only see an 8.1% reduction. Furthermore, the Robert Wood Johnson Foundation highlights that expanding Medicaid would not only increase health equity across states but also enhance health outcomes, especially for populations of color, while also bolstering healthcare providers and generating employment opportunities.
Demographic Impact and State Decisions: The decision to expand Medicaid is inherently a state choice, but its impact varies across demographics. Black adults would benefit the most, with a 43.2% reduction in uninsured rates. Furthermore, young adults between the ages of 19 to 24, the group with the highest rate of uninsurance, would see a 32.4% decrease. However, political considerations often play a role, with state Republicans frequently opposing the expansion due to concerns about increased federal program spending. For example, Georgia has introduced a unique Pathways to Coverage program with a work requirement, but it has seen limited success with just 1,343 enrollments.
8 in 10 Americans rank health among their priority workplace benefits
By Fidelity Health - With annual enrollment season in full swing, many Americans are facing the pressure of selecting health benefits for themselves and their families. Encouragingly, 8 in 10 Americans rank health benefits among their top priorities for workplace benefits, according to a new Fidelity Health study. Read Full Article…
VBA Article Summary
Annual Enrollment Overwhelm: More than half of the respondents (56%) feel "overwhelmed" or "discouraged" by the idea of annual enrollment. While annual enrollment decisions are crucial for overall wellness, creating a care plan that makes optimal use of chosen benefits poses challenges. With the right strategy, however, the enrollment period can be viewed as an opportunity for a healthier future rather than a source of stress.
Importance of Benefits Education: Although employers are significantly investing in health-related benefits, there is a clear gap in understanding among clinicians and employees. Only 35% of clinicians know specific details like which drugs are covered or in-network providers under their patients' plans. To bridge this gap, clinicians recommend that employers provide more "high-touch" support, like workplace education. This will empower employees to have meaningful conversations with their care providers and help them choose the best health plan tailored for their needs.
Understanding Health Savings Accounts (HSAs): Health benefits are intricate, and many Americans struggle with basic terminologies such as "deductible" and "copay". Understanding one's health needs, especially using previous year's expenses as a guideline, is essential. HSAs, which offer triple-tax advantages, are a valuable resource, especially for individuals in high deductible health plans. Yet, misconceptions abound: 49% of respondents are familiar with HSA features, while many mistakenly believe that HSA funds expire yearly or are unaware that HSA funds can be invested for potential growth.