What the funding deal means for health care

By Ben Leonard and Chelsea Cirruzzo - SHUTDOWN AVERTED — Congress came together Saturday to secure a last-minute deal to continue government funding for 45 days and avoid a government shutdown, bucking the overwhelming consensus that a shutdown was inevitable. Read Full Article…

VBA Article Summary

1. Temporary Funding Through Continuing Resolution: The Continuing Resolution (CR) will sustain government agencies, including the Department of Health and Human Services (HHS), at their existing funding levels until November 17. This temporary measure garnered support from over 200 House Democrats, providing a crucial lifeline to Republicans and House Speaker Kevin McCarthy, who struggled to consolidate support for a government funding deal.

2. Provisions within the Continuing Resolution: The CR package is designed to maintain essential health programs and services temporarily. Notably, it:
   • Ensures continuous funding to community health centers, preventing drastic cuts that would otherwise affect safety-net hospitals serving significant Medicare and Medicaid populations.

   • Allocates sustained funds for the National Health Service Corps and the Teaching Health Center Graduate Medical Education program.

   • Extends the Special Diabetes Program and the Special Diabetes Programs for Indians.

   • Allows the National Disaster Medical System to request federal worker support in responding to public health emergencies.

3. Avoided Consequences and Uncertain Future: Without the CR, the government would face a shutdown, significantly impacting public health operations. For instance, the FDA would have been forced to halt inspections and furlough nearly half its workforce, and a large portion of NIH staff would also face furloughs. Furthermore, community health centers, crucial for patients irrespective of their paying capacity, would risk losing staff. Although the CR prevents these immediate challenges, the future is uncertain, as lawmakers must still navigate towards a consensus on long-term government funding solutions, amidst ongoing political conflicts and disagreements.

House Ways and Means Approves Legislation to Expand Use of HSAs

By Remy Samuels - In an effort to expand eligibility for those wishing to establish and contribute to health savings accounts, the House Committee on Ways and Means approved legislation on September 28 with the goal of making out-of-pocket health care costs more affordable. Read Full Article…

VBA Article Summary

1. Increased Access and Flexibility: The bipartisan HSA Improvement Act (H.R 5688) aims to grant broader access and greater flexibility to Health Savings Accounts (HSAs). It proposes allowing individuals who utilize significant health services, like direct primary care or worksite health clinics, to contribute to an HSA. The legislation also suggests the capability for individuals to transfer funds from Flexible Spending Accounts (FSAs) or Health Reimbursement Arrangements (HRAs) to HSAs, enhancing the flexibility and utility of these tax-advantaged accounts. Additionally, it seeks to remove restrictions on individuals whose spouses have FSAs, enabling more families to benefit from HSAs.

2. Raised Contribution Limits & Expanded Eligibility: The HSA Modernization Act introduces changes designed to increase the utility of HSAs for various participants. Firstly, it proposes raising the maximum annual contributions to HSAs, aligning them with the total annual deductible and out-of-pocket expenses allowed under High Deductible Health Plans (HDHPs). For instance, in 2023, the contribution limits would be set at $7,500 for individual coverage and $15,000 for family coverage. Secondly, the act expands eligibility for HSAs to groups including veterans under the Veterans Administration, working seniors enrolled in Medicare, Native Americans, and participants in specific health benefit exchange plans. This expansion aims to provide more individuals with access to the financial benefits and flexible care options offered by HSAs.

3. Enhancing Knowledge and Utilization: Despite the growth in the HSA industry, with assets totaling $116 billion in the first half of 2023, there is a noticeable knowledge gap among employees regarding the uses and benefits of HSAs. The 2023 Voya Consumer Insights and Research study revealed that while awareness of HSAs for retirement healthcare costs has increased, understanding of other benefits and uses, such as investment opportunities and eligibility criteria, has remained stagnant. To bridge this knowledge gap, it is crucial for employers, benefits brokers, financial professionals, and consultants to collaborate in educating participants on the functionalities and advantages of HSAs, ensuring that more individuals can effectively utilize these accounts to cover their healthcare expenses.

Stop-loss premiums increased 16% from 2021 to 2023, survey finds

By Alan Goforth - High-dollar claims remain a key driver of increased costs in employer-sponsored health plans. As a result, individual stop-loss premiums increased by 7% to 16% or more from 2021 to 2023, according to the latest Aegis Risk Medical Stop-Loss Premium Survey, which was cosponsored by the International Society of Certified Employee Benefit Specialists. Read Full Article…

VBA Article Summary

1. Leveraged Trend Dynamics: The article delineates the phenomenon known as the leveraged trend. This dynamic occurs when the financial burden of increasing catastrophic medical claims is fully borne by an unaltered stop-loss deductible year-over-year. In situations where a participant in a health plan faces enormous medical bills (specific or individual stop-loss coverage) or when there is a significant uptick in the frequency of substantial claims overall (aggregate coverage), stop-loss insurance serves as a safeguard for self-funded health plans against unpredictable and large expenses.

2. Deductible Variations and Premium Costs: The deductibles for individual stop-loss coverage are often determined based on the size and risk tolerance of the employee population under a plan sponsor. These deductibles vary considerably, ranging from $50,000 to over $1 million per covered participant each policy year. Consequently, there is a notable fluctuation in the average premium cost per covered employee, primarily dependent on the size of the deductible. For instance, the survey mentioned in the article illustrates that an average monthly premium per covered employee is $193 with a $100,000 deductible, $44 with a $500,000 deductible, and $14 with a $1 million deductible.

3. Catastrophic Claims & Aggregate Coverage: About 25% of survey respondents disclosed having experienced a catastrophic claim surpassing $1 million within the past two years, with 7% of those claims being over $2 million. The spike in these catastrophic claims is attributed not only to aggressive billing practices by hospitals but also to the costs associated with specialty pharmacies and orphan drug therapies. Meanwhile, aggregate stop-loss coverage is more common with individual stop-loss deductibles of $250,000 or less and enrollment numbers around or below 1,000. Notably, 93% of respondents with aggregate coverage have a coverage level set at 125% of expected health claims, with the median premium overall standing at $8.55.

These 10 Trends Are Affecting The Healthcare Economy The Most

By Katie Adams - Last week, healthcare-focused market research firm Trilliant Health released a report detailing the most significant economic trends affecting stakeholders in the U.S. healthcare sector this year. Some of the main ideas covered in the report included Americans’ worsening physical and mental health, the industry’s shift away from traditional care pathways, and the way patients’ decision making is becoming increasingly driven by consumerism. Read Full Article…

VBA Article Summary

1. Decline in Commercially Insured Population: The percentage of commercially insured Americans, a crucial revenue source for healthcare, decreased by 0.3% from 2021 to 2022. Multiple factors contribute to this decline: millions lost coverage due to employment changes and procedural issues, leading to a pause in Medicaid redeterminations in several states; the aging population with births not compensating for those aging into Medicare; and migration patterns affecting insured rates in various regions. The changes in the commercially insured sector are poised to affect almost every healthcare provider’s payer mix.

2. Deteriorating Physical and Mental Health: The mortality rate for Americans under 40 has seen an alarming increase in 42 states, with overdose deaths being a significant contributor. There’s a noticeable decline in demand for primary and preventive care, with cost being a primary deterrent for patients. Essential medication is also skipped due to rising drug costs. Heart health issues are increasing among young Americans, while the demand for mental and behavioral health services is skyrocketing, particularly among the youth.

3. Emergence of New Patient Needs: There’s a significant investment in drugs and diagnostics that address emerging patient needs, with a focus on genetic diseases and cancer. Despite potential breakthroughs in cell and gene therapies, adoption is slow due to the complex and expensive patient journeys involved. GLP-1 weight loss drugs have seen a 300% increase in prescriptions from 2020 to 2022, addressing off-label uses beyond type 2 diabetes treatment. The changing landscape signifies a shift in healthcare, with drugmakers and stakeholders adapting to the emerging needs of patients.

4. Additional Insights: Patients increasingly prefer non-traditional care pathways like retail clinics and telehealth for convenience. The healthcare provider supply is dwindling, with more physicians leaving the practice than entering, and non-traditional healthcare providers vying for the available professionals. Despite rising costs, employers are getting lesser value from healthcare services, while the majority of Americans view the healthcare system negatively. These factors, combined with the increasing demand for transparency and alignment in healthcare pricing, indicate significant challenges and transformation in the U.S. healthcare economy.

Medicare enrollment begins in 2 weeks. Here's what major payers are offering for 2024

By Paige Minemyer - The industry is just two weeks away from the beginning of Medicare's annual enrollment period, a critical window for the hottest market in insurance. Read Full Article…

VBA Article Summary

1. Enrollment Period and Offerings Overview: The Medicare open enrollment period runs from October 15 to December 7, during which beneficiaries can opt for either the fee-for-service program or Medicare Advantage (MA). During this time, beneficiaries can also select prescription drug benefits and various supplemental offerings tailored to their needs for the upcoming year. The Centers for Medicare & Medicaid Services (CMS) anticipates a 4% increase in MA premiums for 2024, but most members sticking with their current plans are expected not to feel the impact. MA enrollment is projected to rise to 33.8 million, covering approximately 50% of all Medicare eligibles.

2. Major Players’ Plans for 2024: Several major insurance providers have unveiled their plans for 2024. UnitedHealthcare, the largest MA carrier, is expanding its coverage to an additional 110 counties, encompassing 96% of Medicare consumers. Humana plans to offer MA plans in 39 new counties, making them available in 94% of counties nationwide. Elevance Health is expanding to 91 counties, aiming to reach 93% of Medicare eligibles with a focus on simplicity and choice. Aetna is expanding into 255 new counties, providing access to an additional 2.2 million Medicare beneficiaries, marking their largest Medicare offering in history. Finally, Cigna is expanding its footprint to 603 counties across 29 states with a $0 premium plan available in every market.

3. Plan Features and Innovations: Different carriers are introducing a variety of plan features and innovations for 2024. For instance, UnitedHealthcare members will have user-friendly offerings tied to their UCard and UCard Hub app for convenience. Humana emphasizes affordability and network flexibility, with Open Network Medicare Advantage PPO plans available in select markets. Elevance Health eliminates prior authorization requirements for commonly used services and provides real-time approvals for many others. Aetna offers a fitness reimbursement option for activities members enjoy the most. Cigna offers home delivery of post-hospitalization meals and access to fitness benefits, with rewards available for volunteerism and wellness initiatives. Each company aims to offer comprehensive coverage, including for dental, vision, and hearing services, with various additional benefits and allowances to cater to members' unique health and financial needs.

Addressing employee mental health and wellbeing in remote settings

Analysis by HR Daily Advisor - The ability to work remotely has been a big boon for both employees and organizations. COVID-19 accelerated experiences in working virtually for a significant portion of the workforce. But, while the digital age has powered the ability to work remotely, and conveniently, from virtually anywhere, as the boundaries between professional and personal lives have blurred, the mental toll of remote work is becoming increasingly evident. Read Full Article…

VBA Article Summary

1. Mitigating Remote Work Challenges:

   Understanding Remote Work Strain - Managers and supervisors should be educated about the unique stressors remote and hybrid work can bring to employees, including feelings of isolation and burnout from blurred work-life boundaries. The awareness of these challenges is essential for supporting the mental health of remote workers effectively.

   Providing Active Support - Proactive strategies are crucial to mitigating the negative effects of remote work. This support may involve regular check-ins, careful observation of employees during virtual meetings, and frequent surveys to assess their satisfaction and engagement levels. Understanding and recognizing the signs of mental health struggles in remote workers are essential first steps, but they must be accompanied by active support and resource provision.

   Offering Mental Health Resources - Employees should have access to resources that address their mental health needs, including counseling services and encouragement to take mental health days. It’s crucial to create an environment where workers feel comfortable seeking help without fear of stigma or professional repercussions.

2. Fostering a Supportive Remote Culture:

   Regular and Open Communication - To combat the isolation often associated with remote work, supervisors and managers should establish regular communication channels with remote employees. Consistent check-ins and opportunities for virtual and in-person interactions among team members help in building a supportive remote work culture.

   Team-Building Initiatives - Engage employees in virtual team-building activities to foster a sense of camaraderie and belonging, even while working apart. These efforts contribute to creating a workplace environment where struggles can be shared openly without fear of judgment.

   Ongoing Training for Leadership - Managers should receive ongoing training and support to effectively promote and maintain a supportive remote culture, understanding how to navigate and address the challenges their subordinates face in these work arrangements.

3. Leveraging Technology for Employee Wellbeing:

   Digital Tools for Mental Health Support - In today’s digital age, there are numerous tools available that can support employees’ mental health. Meditation apps, virtual fitness programs, and online communities can offer support, shared experiences, and respite for remote workers.

   Encouraging Usage of Wellbeing Platforms - Managers should not only provide these tools but also actively encourage their use among employees, incorporating them into the daily or weekly routine as necessary.

   Balancing Productivity and Wellbeing - While technological tools play a significant role in maintaining productivity in remote work setups, it's imperative for organizations to prioritize employees' mental health and wellbeing as equally important to achieving business goals and sustaining a healthy, engaged workforce.

How to address top 2024 open enrollment concerns

By Nate Black - With open enrollment season fast approaching, working Americans are gearing up to make their benefit elections for 2024. Over the past few years, we’ve seen COVID-19 and inflation influencing the decision making for many. While inflation has moderated, many individuals are experiencing pain from elevated prices. Read Full Article…

VBA Article Summary

1. Adapting to Inflation-Driven Financial Strains: Inflation is a substantial concern for 79% of working Americans, notably influencing their perceptions and expectations regarding workplace benefits. As employees grapple with rising costs and competing financial obligations, employers and benefits advisors must acknowledge and respond to these stressors proactively. With 72% of workers planning to meticulously review their benefits during open enrollment, providing clear, inflation-sensitive options and support is essential for fostering financial security and confidence among the workforce.

2. Addressing Financial Stress and Mental Health: There’s a tangible link between financial stability and mental health, with financial stresses detrimentally affecting the mental wellbeing of over half of full-time employees. Recognizing this correlation is pivotal for employers. Approximately 63% of workers believe their mental health directly influences their job performance, and 55% feel employers should actively support their mental and emotional health. Implementing benefits that address both financial and mental health concerns, therefore, is not just beneficial but expected by employees, enhancing their overall wellbeing and productivity.

3. Holistic Support and Guidance: The majority of employees (79%) express a keen interest in receiving assistance to optimize their workplace benefits, underscoring the demand for support and guidance in navigating benefits related to retirement, health savings, and insurance. Employers and advisors who offer integrated, year-round support that aligns with employees’ financial and health concerns not only facilitate effective benefits utilization but also bolster employee confidence and reduce stress. Continuous engagement and communication about benefits, even outside the open enrollment period, can significantly influence and support employees throughout the year.

Cigna Group announces settlement with US on claims it overcharged Medicare Advantage program

By Reuters - Health insurer Cigna Group (CI.N) says it has reached a settlement with the United States over claims it overcharged the government's Medicare Advantage program by making it appear patients were more ill than they actually were. Read Full Article…

VBA Article Summary

1. $172 Million Settlement: The article begins by highlighting a significant settlement reached on a Friday, with Cigna agreeing to make a payment of approximately $172 million. This payment is part of a resolution to accusations and legal issues surrounding the company's dealings and operations related to Medicare funds.

2. Corporate Integrity Agreement: In addition to the monetary settlement, Cigna will enter into a Corporate Integrity Agreement with the U.S. Office of Inspector General. This agreement signifies that the company is committing to abide by certain ethical and operational standards to ensure compliance with laws and regulations, reflecting an effort to restore and maintain public and governmental trust after the settlement.

3. False Diagnoses Accusations: U.S. prosecutors based in Manhattan made serious accusations against Connecticut-based Cigna in October 2022. They claimed that the company unlawfully obtained tens of millions of dollars from Medicare funds between 2012 and 2019. According to the prosecutors, Cigna submitted false diagnoses for patients, securing funds for cases where the necessary tests were not conducted by the healthcare providers retained by the company. These accusations led to the aforementioned settlement and corporate integrity agreement.