Daily Insurance Report - October 27, 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.
The new House Speaker’s views on health topics
By Nathaniel Weixel and Joseph Choi - The House has a new speaker, but Mike Johnson (R-La.) faces the same challenges that beset Rep. Kevin McCarthy (R-Calif.) in finding enough Republican votes to pass legislation. In the short-term, he will need to tackle FY 2024 appropriations before the Nov. 17 deadline. Read Full Article…
VBA Article Summary
Key Legislative Concerns: Johnson must address several "extenders" that ended in September, crucially including the Pandemic and All-Hazards Preparedness Act (PAHPA), funds for community health centers, anti-opioid initiatives, and the PEPFAR program fighting against AIDS and HIV.
Stance on Social Issues: Despite serving only four terms in Congress, Johnson has consistently supported anti-abortion and anti-LGBTQ legislation. Notably, he's sponsored bills targeting abortion restrictions nationally and voted against embedding same-sex marriage into law.
Republican Health and Budget Plans: As chairman of the Republican Study Commission, Johnson played a central role in the 2019 health plan and the fiscal year 2020 budget. Both proposed significant changes: the former revisited repealing the Affordable Care Act, introducing capped federal Medicaid funds, and altering coverage for those with pre-existing conditions, while the latter suggested raising the Medicare eligibility age and altering its structure. With a potential Republican-controlled Congress and White House post-2024, these policies could provide insights into future health priorities.
The Data Tsunami is Here—And it’s Time for “Smart” Views of Clinical Data
By David Lareau - A few years ago, some colleagues and I were discussing the implications of the “post-EHR” world, where everyone has electronic health records and, with the pending mandates of the 21st Century Cures Act, systems would soon be required to share data. This discussion arose from the ongoing issue that clinicians still struggle to find clinically relevant information in a patient’s medical record. Read Full Article…
VBA Article Summary
Challenges with Current EHR Systems: The current "legacy" Electronic Health Record (EHR) systems present significant obstacles in locating and accessing clinically relevant data. While these systems house a wealth of information like medication lists, lab results, physician notes, etc., much of this information is trapped in free-text notes. Consequently, users end up spending a considerable amount of time searching for clinically relevant items. Moreover, with the exponential increase in health data, particularly from wearable tech like the Apple Watch "ultra", clinicians face the daunting task of sifting through vast amounts of unconnected and potentially irrelevant data.
Emergence of Wearable Tech & Data Overload: The rapid evolution and adoption of wearable technologies introduce another layer of complexity. Devices such as the Apple Watch "ultra" and home EKGs generate an unprecedented volume of health data. While this data holds potential for more comprehensive patient monitoring, its sheer volume poses a question: how can clinicians possibly aggregate, organize, and interpret thousands of data points effectively? This issue is exacerbated when considering the need for this data to be diagnostically relevant, connected, and integrated with existing EHR systems.
The Need for Intelligent Viewers & Universal Tools: Addressing the aforementioned challenges necessitates the development of intelligent viewers capable of converting unstructured data into structured data. These tools must offer clinicians a smart, tailored view, enabling them to quickly understand a patient’s condition amidst the data deluge. Additionally, given that legacy EHRs aren't disappearing soon and their inherent limitations, the healthcare industry needs universal platforms. These platforms should seamlessly integrate diverse terminologies, coding systems, and data schemas to support clinicians at the point of care, thereby elevating the quality of care and advancing the medical field.
How Digital Is Reshaping Pharma’s Patient Journey
By Kal Patel, MD - Traditionally, innovation in the pharmaceutical industry has been centered around the development of new medications for existing conditions – new vaccines or therapies to manage or even cure conditions once thought impossible to treat. The most recent example: researchers used messenger RNA (mRNA) to rapidly develop vaccines to treat COVID-19, and are also investigating its potential to generate treatments or vaccines for a variety of other conditions, including influenza, respiratory syncytial virus (RSV), malaria, human immunodeficiency virus (HIV), tuberculosis, the Zika virus and cancer. Read Full Article…
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Enhancing Drug Delivery with Digital Technology: Digital innovations have transformed traditional methods of drug delivery, especially for chronic conditions. New tools include smaller and thinner needles, autoinjectors, and needle-free systems. Digital tools like smart “pens” assist with insulin delivery, dosage calculations, and carb estimation, complemented by companion apps that guide device setup, monitor glucose levels, adjust dosages, and automate pharmacy refills. Continuous glucose monitors integrated with mobile devices allow diabetic patients real-time tracking, reducing risks by notifying users about potentially dangerous glucose levels.
Digital Solutions Supporting the Patient Journey: Navigating insurance for specialty drugs often involves tedious manual processes. Digital companion apps simplify these processes with secure document exchanges, benefits verification, and authorization streamlining. Surveys highlight the challenges faced due to medication costs. Digital Patient Support Programs (PSPs) provide assistance on these fronts, offering information on medication costs, support services, and medication reminders. An integrated digital approach to patient support can expedite the initial prescription fill and ensure sustained therapy adherence.
Digital Care for a Holistic Patient Approach: The healthcare industry's shift towards a "whole patient" approach is championed by digital technologies, which support varied aspects like drug administration, remote monitoring, education, and surveys. Companion apps facilitate real-time tracking of symptoms and medication experiences, allowing patients comfort and familiarity. Such digital tools benefit not only patients but also pharmaceutical companies, offering insights into real-world data. With this information, providers can identify challenges in adherence and proactively support patient engagement.
Rent, food or health care? People make tough choices amid rising health costs, debt
By Ken Alltucker - Half of working-age Americans struggle to pay for health care, and 1 in 3 Americans owe money to a hospital, doctor, or other health care provider, a new survey shows. Read Full Article…
VBA Article Summary
Affordability and Access to Healthcare: A recent survey by The Commonwealth Fund revealed that nearly 2 in 5 Americans have either skipped or delayed medical care, or haven't filled a prescription due to financial constraints in the past year. Despite having health insurance through workplaces or other sources, many still face financial burdens when it comes to accessing healthcare. Among those surveyed, 38% delayed or skipped necessary medical treatment because they couldn't afford it, leading more than half of these individuals to experience worsening health problems.
Medical Debt and Its Consequences: One in every three adult Americans owes money to healthcare providers, ranging from doctors and dentists to hospitals. This debt often stems from both routine and emergency care. Nearly half of those in debt owe sums upwards of $2,000. The weight of medical debt is evident in its impact on the economy; in 2021, consumers owed around $88 billion in medical bills, making it the predominant consumer debt category. This kind of debt can significantly affect an individual's financial stability, limiting their ability to purchase homes or finance cars. Moreover, approximately one-third of adults with past-due medical bills have had their debts transferred to collection agencies, which can further impair their credit scores.
Emotional and Economic Strain: The financial strain of healthcare isn't just limited to the bills. It has profound effects on Americans' emotional and economic well-being. Many survey respondents expressed heightened levels of anxiety and worry due to their medical debts. Financial sacrifices also became necessary for many to manage these costs: 39% reduced spending on essential items like food, heating, or rent; 37% utilized all or a portion of their savings; and 25% either took on additional employment or increased their working hours. Joseph Betancourt, president of The Commonwealth Fund, emphasized the severe ramifications of these affordability issues, noting their role as a significant threat to individuals' health and overall welfare.
Biden admin rolls out cybersecurity toolkit for health care
By Tina Reed - The Biden administration is ramping up efforts to harden defenses around the U.S. health care infrastructure, releasing an updated cyber "toolkit" to help the sector better defend against hackers. Read Full Article…
VBA Article Summary
Cybersecurity Threats in Healthcare: Health care has become an attractive target for cyber attacks, leading to significant disruptions in patient care. This has raised concerns about patient safety, especially when care providers are forced to divert or suspend their services. As such, there's an increasing emphasis on bolstering the cybersecurity framework within the industry. Notably, even larger health systems, despite having more resources, often find themselves struggling with the complex web of state and federal cybersecurity regulations.
Governmental Efforts to Enhance Cybersecurity: Recognizing the gravity of the situation, top officials from the Health and Human Services Department (HHS) and the Cybersecurity and Infrastructure Security Agency (CISA) are stepping up their collaborative efforts. A toolkit, which offers guidance on mitigating cyber risks through vulnerability scanning, best practices, and a cyber resilience framework, was recently released. This toolkit is a continuation of the series of tools rolled out by the HHS over the past year, aiming to improve cyber hygiene across the health sector.
Collaboration & Peer Support: One unique strategy employed by the HHS, as highlighted by Deputy Secretary Andrea Palm, is connecting health systems under cyber attack with peer organizations that have previously faced similar challenges. This approach provides victimized entities with a knowledgeable partner, ensuring they're not navigating the crisis blindly. The intent is to allow them to glean insights from those who have previously navigated through such cyber threats, fostering a supportive network within the industry.
More Workers ‘Terrified’ They Cannot Afford Health Care in Retirement
By Noah Zuss - Inflation is pressing U.S. workers to delay medical care and downgrade health insurance as they lose confidence in their ability to afford health expenses and to maintain their physical and financial health in retirement. Read Full Article…
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Growing Concerns about Health Care Costs in Retirement: A Nationwide Institute survey revealed that 66% of U.S. adults are alarmed about the potential effect of health care costs on their retirement plans. 72% identified soaring health care expenses as one of their chief fears in retirement, and 61% are apprehensive about outliving their savings. This fear is also prevalent among older adults, with 62% of those aged 50 and above expressing concern over health care expenses affecting their retirement, up from 56% in 2014.
Compromises and Underestimations Due to Health Care Expenses: To cope with medical costs, 18% of adults delayed health care activities in the past year, and 10% contemplated downgrading their health insurance plan, mainly due to inflation. Despite their concerns, workers significantly underestimate the projected health care costs in retirement. While they anticipate an average expense of $55,343, Fidelity Investments' estimate stands at $157,500 for an individual and $315,000 for a 65-year-old retired couple.
AI and Medical Advancements Impacting Longevity and Financial Planning: A notable 26% of the surveyed participants believe that advancements in AI-driven health care will add over a decade to their lifespan. Generation-wise expectations regarding AI's impact on lifespan vary: Gen Z foresees a 15-year addition, Millennials 12 years, Gen Xers eight years, and Baby Boomers expect an increase by nine years. Kristi Rodriguez of Nationwide Retirement Institute highlighted the swift progress in AI and health care technology, emphasizing the importance of planning for increased longevity due to these advancements.
Vitamin retailer GNC enters health market with virtual urgent, primary care
By Alan Goforth - A familiar name has joined the rapidly growing list of retailers attempting to disrupt the health-care industry. GNC, a longtime nutrition and wellness company, will begin offering membership plans that include virtual urgent and primary care. Read Full Article…
VBA Article Summary
Introduction of GNC Health: GNC Health is a new service that builds upon the supplemental health-care offerings provided to GNC PRO Access members earlier in July. The service originally offered members telehealth appointments, 40 generic versions of urgent-care medications, and over 70 generic personal health medications. Now, PRO Access members have the flexibility to either retain their current plan or opt for an upgrade. Allison Bentley, the senior director of strategic programs, sees GNC Health as a means to extend consumer outreach and provide meaningful health solutions. The initiative aims to keep the GNC brand relevant and prioritized in consumers' minds.
Plan Details: Three distinct plans are available under GNC Health:
Basic Plan - Priced at $34.99 annually, it offers unlimited access to virtual urgent and lifestyle care along with over 100 prescription medications.
Plus Plan - Available at $9.99 monthly for individuals or $29.99 for families, it provides access to virtual urgent, primary, and lifestyle care, complemented by more than 400 prescription medications.
Premier Plan - At a rate of $39.99 monthly for individuals and $59.99 for families, it incorporates all features of the other plans but with added virtual mental health and physical therapy care services.
Virtual Care in the Retail Sector: The launch of GNC Health signifies a larger trend in the retail industry, with multiple retailers venturing into virtual care services. Earlier this month, both Costco and Walmart disclosed collaborations centered on virtual care. While Costco is teaming up with the health-care marketplace platform Sesame for virtual primary care, Walmart aims to enhance its no-copay virtual primary care service for employees and their families, in alliance with Included Health. Other technology giants and retail pharmacy chains, including Amazon and Walgreens, are also entering this domain. As per Chris Lew from Rock Health Advisory, retailers possess a competitive advantage in the virtual-care domain due to their physical scale and community presence. This equips them to offer a seamless omnichannel experience, integrating various services under a single 'roof'.
AMA President warns physician shortage is 'urgent crisis'
By Christopher Cheney - A slew of factors is driving the country's physician shortage, including burnout, shrinking Medicare reimbursement, an aging workforce, administrative burdens, and efforts to criminalize care, American Medical Association President Jesse Ehrenfeld, MD, MPH, said yesterday in a National Press Club address. Read Full Article…
VBA Article Summary
Magnitude of the Crisis: The U.S. is grappling with a significant physician shortage, estimated to be between 37,800 to 124,000 by 2034. Within these figures, the shortage of primary care physicians is projected to be 17,800 to 48,000, while specialist shortages are expected to range from 21,000 to 77,100. This shortage means over 83 million Americans currently reside in areas with inadequate access to a primary care physician. Specific medical needs, such as OBGYN care for pregnant women in regions like Idaho and Mississippi, are not met. Furthermore, vast portions of the country lack pediatric ophthalmologists and infectious disease specialists, and a significant portion of Black Americans live without nearby cardiology services.
Underlying Factors: A concerning number of doctors reported feeling burned out, especially during the coronavirus pandemic. As many as 20% of the physicians surveyed considered leaving the profession within two years, and around half of them are over 55 years old. The financial challenges for new doctors are daunting, with the average medical school debt exceeding $250,000. This debt burden often propels them towards higher-earning specialties, exacerbating the primary care shortage. The dwindling Medicare reimbursement rates, which have fallen 26% since 2001 after adjusting for inflation, are pushing physicians away from serving Medicare patients and, in some cases, leading to practices shutting down.
Proposed Solutions and the Call for Action: Ehrenfeld highlights a five-point plan to address the physician shortage, including reforming Medicare payment structures, easing administrative workloads, expanding residency training and student loan support, decriminalizing certain aspects of healthcare, and fostering an environment that prioritizes physician mental health. These proposals, many of which have gained bipartisan support in Congress, aim to fortify the physician workforce in the face of an evolving national landscape. Congress is urged to take swift action, with emphasis on the bipartisan agreement on this issue. Delays only exacerbate the public health crisis, underscoring the urgency of resolving the physician shortage for the well-being of the American populace.