Bipartisan legislation seeks to increase healthcare price transparency

By Jeff Lagasse - New bipartisan legislation intended to increase healthcare price transparency and lower overall costs for patients and employers was introduced late last week in the U.S. House of Representatives, and seeks to provide patients with accurate information about the cost of procedures and services. Read Full Article…

VBA Article Summary

1. Comprehensive Scope for Transparency and Affordability: Introduced by members of the House representing both political parties, the "Lower Costs, More Transparency Act" is a multi-faceted piece of legislation aimed at overhauling various aspects of the healthcare system to make pricing more transparent and reduce costs. The bill mandates public listing of price information from a range of healthcare providers and aims to lower out-of-pocket expenses for seniors. It also proposes funding investments to strengthen the healthcare system, including support for community health centers and training programs for doctors new to their communities, while safeguarding Medicaid funding for hospitals serving uninsured and low-income patients and advancing research on diabetes.

2. Industry Opposition and Criticism from PCMA: Despite its ambitions, the bill faces staunch opposition, particularly from the Pharmaceutical Care Management Association (PCMA). The association criticizes the bill for potentially escalating the cost of prescription drugs instead of lowering them, by empowering pharmaceutical companies to manipulate the system for higher profits. The PCMA, along with its president and CEO J.C. Scott, has urged Congress to shift its focus towards policies fostering competition in the prescription drug market and dismantling anti-competitive practices by drug companies, rather than targeting pharmacy benefit managers (PBMs) - which, they argue, undermines efforts to reduce drug prices.

3. Continuing Efforts for Healthcare Price Transparency: The introduction of this bill aligns with broader trends emphasizing transparency in healthcare pricing. The Centers for Medicare and Medicaid Services have been enforcing price transparency rules, introduced in 2019 and effective since January 2021, through financial penalties on non-compliant hospitals. However, adherence to these rules has been lackluster, with a survey in 2022 revealing less than 20% of hospitals meeting the compliance standards. This reflects a persistent need for policies and mechanisms that promote greater transparency and accountability in the healthcare sector, to potentially alleviate financial strains on patients and foster a more competitive and efficient system.

Insurance commissioner warns on false Calif. LTC plan information

By Doug Bailey - California’s insurance commissioner, Ricardo Lara, has put long-term care insurers and agents on notice for spreading misleading marketing materials and emails that falsely warn consumers the state is about to implement a new payroll tax and urges them to buy long-term care insurance before the end of the year. Read Full Article…

VBA Article Summary

1. Misleading Marketing Tactics Surrounding LTC Policies:

   Inaccurate Information and Fear Tactics - Certain agents and insurers have been utilizing misleading marketing strategies to persuade consumers to purchase Long-Term Care (LTC) policies before 2024, based on the false pretense that new legislation and taxes have been officially approved and will be implemented by January 1, 2024.

   Government Response - The department has condemned these tactics, actively investigating instances of misleading communications, and potentially taking legal actions against companies and agents involved in disseminating false information.

   Consumer Advisory - The commissioner advises consumers to verify information before making any decisions on purchasing LTC policies, and encourages reporting of any misleading activities to uphold fair and ethical practices within the industry.

2. California's Efforts to Develop a Public LTC Program:

   Task Force's Role and Reports - The California Long-Term Care Insurance Task Force, established in 2019, has been tasked to explore the feasibility of developing a public LTC insurance program and conducting actuarial analysis of proposed program structures.

   Current Progress and Future Expectations - The feasibility report, submitted to the California governor in December, explores various structures and funding mechanisms for a public LTC program. The final actuarial analysis is slated to be submitted by January 2024, although the implementation of any program remains speculative at this point.

3. Industry Perspectives and the Need for Responsible Conversation:

   Slow Progress Criticisms - Some stakeholders have criticized the slow pace of progress in developing a public LTC program, highlighting the growing needs due to the increasing elderly population in California.

   Industry Reaction and Advice - Steve Cain, an industry director, acknowledged that misleading information has been circulated within the industry, partly due to eagerness for a comprehensive state policy on LTC. He advocates for responsible conversations focusing on the real importance of planning for LTC, based on factual information.

   Uncertain Future of the Public LTC Program - The insurance commissioner emphasized that the final decision on the public LTC program, including potential recommendations from the Task Force, remains undetermined, with no current implementations of payroll taxes or "opt-out" dates established.

Newly integrated PCPs 'steer' patients toward systems, driving higher utilization, spending: study

By Dave Muoio - Primary care physicians who become associated with health systems more often steer their patients toward the organization’s services, increasing both utilization and care spending, according to a study published Friday in JAMA Health Forum. Read Full Article…

VBA Article Summary

1. Increased Costs and Specialist Visits in Vertically Integrated Health Systems: The study conducted by Harvard University researchers indicates that vertical relationships between primary care physicians and larger health systems might be contributing to a rise in medical expenses and an uptick in specialist visits. Analyzing over 4 million patient observations in Massachusetts, they noted a significant 22.6% increase in specialist visits per patient year, alongside a 6.3% hike ($350 approx.) in total medical expenditures per patient-year, following a primary care physician's integration into a vertical system. While these affiliations may facilitate improved care coordination, the conspicuous surge in specialist visits necessitates further investigation to determine whether it corresponds to enhanced accessibility or merely translates to low-value care.

2. Unchanged Readmission Rates Amid Higher Within-System Visits: Despite the escalation in specialist visits and medical expenditures, the research did not observe any significant alterations in the rates of patient readmissions, total emergency department visits, or hospitalizations. Even as primary care physicians newly aligned with a system showed a 29.4% increase in specialist visits and higher within-system emergency department visits and hospitalizations (14.2% and 22.4% respectively), the readmission statistics remained steady. This steadiness in readmission rates hints at limited advancements from heightened coordination, questioning the efficacy of vertical integrations in enhancing healthcare access or coordination.

3. Policy Considerations and Regulatory Scrutiny on Provider Consolidation: The observed trends in healthcare provider consolidation have drawn considerable attention from the Biden administration, lawmakers, and regulatory bodies. Policymakers are considering a range of countermeasures, including bolstering antitrust enforcement and introducing more transparency tools for patients to prevent potential market harm without additional benefits for patients. During the summer, entities such as the Federal Trade Commission and the Department of Justice initiated steps to revise guidelines governing antitrust enforcement, particularly focusing on aspects of vertical integration and platforms in determining the approval of mergers. These efforts signify a growing concern and scrutiny over the implications of provider consolidation and vertical integration in the healthcare sector, striving for a balanced approach that guards the interests of both providers and patients.

FDA Approves Updated Covid-19 Vaccines to Address Now Circulating Variants

By Frank Vinluan - Two updated Covid-19 vaccines based on messenger RNA technology now have the FDA’s regulatory nod, setting the stage for the new shots to become available soon as the fall respiratory illness season approaches. Covid-19 vaccines from partners Pfizer and BioNTech as well as Moderna were previously approved for adults. The FDA decision announced Monday extends that approval status to include the updated version of the vaccines. Read Full Article…

1. FDA Approves Updated Version of COVID-19 Vaccines for Pediatric and Adult Use: The FDA extended the approval of the latest version of the COVID-19 vaccines developed by Pfizer-BioNTech and Moderna to include infants aged six months and older as well as children up to 17 years, which were previously under emergency use authorizations. These mRNA vaccines, redesigned to address multiple variants including the Omicron variant XBB.1.5, will undergo a yearly update similar to seasonal influenza vaccines to adapt to the circulating variants. Meanwhile, Novavax's updated version is still awaiting FDA emergency use authorization for individuals aged 12 and above.

2. Monovalent Shots for Targeting Specific Variants: The newly approved vaccines are monovalent shots, created to specifically target the XBB.1.5 variant. Despite the CDC data indicating a different subvariant, EG.5, being the most prevalent, recent studies have shown the vaccines offer neutralization against this and another circulating variant, BA.2.86, suggesting their efficacy in combating the current variants in circulation. The FDA aims to update COVID-19 vaccines annually, unless a significantly more virulent variant emerges, requiring an adjustment to this schedule.

3. Changes to Dosing Schedules and Upcoming ACIP Meeting: The FDA's approval also brings alterations to the dosing schedules; both mRNA vaccines will now be administered as a single shot for individuals aged 12 and older, and the eligibility age for a single dose of the Moderna vaccine has been reduced to 5 years. Additional doses may be provided for certain immunocompromised children between the ages of 6 months and 11 years. The Advisory Committee on Immunization Practices (ACIP) is set to discuss further recommendations on the usage of these vaccines in specific groups, such as older adults and those with weaker immune systems, in an upcoming meeting where Novavax will also present data for its vaccine. Following ACIP's recommendation, the CDC Director Mandy Cohen will give the final approval, facilitating the distribution of updated vaccines in healthcare settings shortly thereafter.

19 Best Practices For Managing Employee Benefits And Compensation

By Expert Panel® and Forbes Human Resources Council - Employee benefits and compensation management lie at the heart of a thriving organization. As the business landscape evolves and employee expectations continue to shift, it's essential for companies to remain agile and strategic in their approach to rewarding and retaining talent. Read Full Article…

VBA Article Summary

1. Strategize and Personalize Compensation and Benefits: Organizations should define their desired market positioning for compensation and benefits, whether it's median, top, or bottom quartile. Align the overall rewards framework with company strategy and cater to diverse employee needs. Understand the unique requirements of your team, from work locations to life stages, ensuring that each group gets appropriate benefits. Prioritize employee understanding of the benefits and compensation being offered to ensure they value the full package.

2. Ensure Fairness, Transparency, and Compliance: Regular pay equity audits are essential to spot and fix disparities, enhancing fairness amidst changes such as promotions or new hires. Emphasize on employee feedback, adjusting offerings as their needs evolve over time. It's crucial to balance company goals with market trends, legal compliance, and the needs of employees. Educate both managers and employees on the basics of compensation, including topics like equity and non-cash compensations, to ensure a transparent environment.

3. Focus on Culture, Well-being, and Continuous Assessment: While benefits and compensation are vital, it's equally essential to have a strong workplace culture, leadership, and team dynamics. Emphasize whole-person well-being by offering comprehensive support solutions that cater to all aspects of an employee's life. Conduct regular benchmarking and analysis, partnering with leadership and finance to maintain a competitive edge in the market. Remember, compensation and benefits are more than just financial perks; they should be positioned as a testament to the organization's commitment to a superior employee experience.

Employer health benefit costs to soar again in 2024. Why?

By Dawn Kawamoto - ​Employers can expect another large hit to their budget next year from the soaring cost of providing employee health benefits, according to two new reports. Based on a survey of 450 employers, Willis Towers Watson expects benefit costs in 2024 to rise by 6%, slightly higher than the 5.7% jump it predicted for 2023. Meanwhile, Mercer’s 2023 National Survey of Employer-Sponsored Health Plans suggests a 5.4% increase next year—similar to the level it forecast for 2023, according to its survey of more than 1,700 employers across the nation. Read Full Article…

VBA Article Summary

1. Rising Health Benefit Costs and Their Underlying Factors: The employer health benefit costs are predicted to experience a significant rise, contrasting the typical annual increase of 3%-4% seen in the past decade. These increases are attributed to various systemic factors, including the consolidation of health systems, introduction of high-cost gene and cellular therapies, and a surge in demand for expensive prescription drugs, particularly those related to long-term illnesses that went unchecked during the pandemic. Notably, Alan Silver highlighted the rise in cancer diagnoses and the increased interest in GLP-1 semaglutide drugs as contributing to the escalating costs.

2. Employers' Response to the Cost Surge: Despite the steep rise in healthcare costs, many employers, particularly those with a workforce of 500 or more, have refrained from transferring the burden to their employees. This trend has been observed for the past five years, with minimal growth in deductibles and other cost-sharing measures. During the pandemic, numerous employees faced heightened financial strains, compelling many employers to absorb these rising costs. Companies are actively pursuing cost-management strategies focusing on complex care and chronic medical conditions, which are significant drivers of healthcare expenses. Strategies like managing high-cost claimants and introducing Centers of Excellence into health plan networks have been prioritized to facilitate better health outcomes and potentially save money in the long run.

3. Forecasting Future Trends in Health Benefit Costs: As the corporate world adapts to the new norm of hybrid work, questions arise regarding the sustainability of the projected 6% annual increase in health benefit costs. Beth Umland notes that the surge in costs mirrors the events of recent years, including high inflation and a tight labor market potentially escalating operation costs due to a talent shortage in the healthcare industry. Conversely, Silver anticipates a possible cost reprieve in the future if the inflationary environment stabilizes, urging HR leaders to stay vigilant about the changing landscape, including emerging gene therapy drugs and other factors that could influence the cost trajectory.

Annuity Riders, Explained

By Roger Wohlner - Annuity riders are add-ons that can be used to enhance and customize the benefits of an annuity contract to better align the contract with your client’s needs. There are a variety of annuity riders available across the insurance industry. However, not all riders are available from every company or for all types of annuity contracts. Read Full Article…

VBA Article Summary

1. Understanding the Benefits and Types of Annuity Riders:

   Living Benefit Riders - These are provisions added to an annuity contract that offer additional benefits during the holder's lifetime. They encompass various types including guaranteed minimum income, accumulation, and withdrawal benefit riders, along with riders catering to inflation adjustment, long-term care needs, disability income, and more. Each of these riders serves to enhance the financial security and adaptability of the annuity to better serve the contract holder in various life circumstances.

   Death Benefit Riders - These riders offer an extra layer of financial protection to the beneficiaries in case of the contract holder's death. They might guarantee a minimum death benefit, ensure the return of premium amounts left at the time of death to the beneficiaries, or offer added financial security to a surviving spouse. Each of these riders can be instrumental in safeguarding the financial interests of the beneficiaries and ensuring that the holder's investment offers value even posthumously.

   Cost vs. Benefits Analysis - While annuity riders offer a customized approach to building an annuity contract that caters to the specific needs and circumstances of an individual, they come at a cost. It's imperative to evaluate the cost against the potential benefits and to consider the varying prices based on different factors like the type of rider, the insurer, and the specific contract details.

2. Navigating the Complex Landscape of Annuity Riders:

   Living Benefit Riders - These riders help in mitigating the risks associated with market fluctuations and other unpredictable elements that might affect the annuity's performance. By setting minimums on various benefits and offering provisions to cover specific situations like disability or terminal illness, they offer a safety net that can enhance the attractiveness of the annuity as a long-term investment vehicle.

   Death Benefit Riders - These additions to the annuity contract are aimed at safeguarding the interests of the beneficiaries in case of the holder's premature death. They ensure that the investment in the annuity does not go to waste and that the beneficiaries receive a substantial benefit, aligning with the contract holder's intentions and wishes.

   Cost-Efficiency Consideration - Given the additional costs associated with these riders, a critical analysis of the cost versus the benefits offered is necessary. This analysis should be focused on ensuring that the riders chosen align well with the individual's financial planning and goals, offering value that justifies the additional expenditure.

3. Customizing Annuity Contracts for Personalized Financial Planning:

   Living Benefit Riders - These riders play a crucial role in tailoring the annuity contract to cater to the individual's personal financial landscape. From offering protection against market fluctuations to providing increased payouts in case of specific health conditions, they serve to make the annuity a more flexible and personalized financial tool.

   Death Benefit Riders - Through these riders, an annuity contract can be crafted to offer protection and financial security to the loved ones of the holder. They can help in defining the financial legacy that the holder wishes to leave, with provisions that ensure substantial benefits for the beneficiaries in various circumstances.

   Analyzing Costs and Benefits for Optimal Planning - When adding riders to an annuity contract, a balanced approach that weighs the costs against the potential benefits is vital. This approach helps in creating a contract that is aligned with the individual's financial goals and aspirations, offering a level of customization that makes the annuity a more effective and suitable investment option.

Large Employers Expect More Employees Will Experience Prolonged Health Impacts Due to COVID-19. and a Note About Telehealth Engagement

By Jane Sarasohn-Kahn, MA, MHSA - Due to their delayed return to medical services and diagnostic testing in the COVID-19 pandemic era, U.S. employees are expected to sustain serious health impacts that will drive employers’ health care costs, envisioned in the 2024 Large Employer Health Care Strategy Survey from the Business Group on Health (BGH). Read Full Article… 

VBA Article Summary

1. Mental Health and Chronic Condition Management in the Workplace (2023-2026):

   2023 Focus on Mental Health - A majority of large companies are focusing on addressing mental health issues, which have become a paramount concern for the well-being of their employees.

   Anticipated Rise in Chronic Conditions and Cancer Cases - Due to delayed screenings, employers are preparing for an increase in later-stage cancer diagnoses and chronic conditions, which are expected to be the top factors driving medical costs in the upcoming years.

   Health Equity Initiatives (2025-2026) - Large US employers are aiming to promote health equity with various strategies, including partnerships with vendor/health plans and launching dedicated care navigation programs for marginalized groups.

2. Challenges in Implementing Virtual Health Care:

   Declining Confidence in Virtual Health Care - The 2024 BGH survey shows a declining trend in large companies' belief in the potential impact of virtual health care on future healthcare delivery.

   Concerns Surrounding Virtual Care - Employers are apprehensive about the effectiveness of virtual health care due to issues such as siloed care, quality of care, lack of vendor integration, and the proliferation of too many solutions.

   Mitigating Concerns Through Collaboration - To address these concerns, there is a need for collaborations with telehealth providers capable of integrating health records and ensuring quality through streamlined digital systems.

3. Economic Impact and Future Projections:

   Rising Healthcare Costs - Aon's latest forecast indicates an anticipated rise in healthcare costs by 8.5% for 2024, amounting to over $15,000 per employee, if no mitigative actions are taken by employers.

   Possible Reassessment of Virtual Care Utilization - Given the growing caution towards telehealth programs, large companies might reconsider their stance and strategies concerning virtual health care in the coming years.

   Continued Support for Telehealth Despite Concerns - Despite the noted decline in confidence, a significant portion of large companies (64%) still believes that virtual health care will have a substantial impact on the future of healthcare delivery, indicating the potential for further developments and adaptations in this sphere.