WSJ shows insurers make patients pay thousands for cheap generics while Brookings thinks Congressional PBM reforms could fall short

By Wendell Potter - Over the past few days, both the Brookings Institution and The Wall Street Journal published reports on pharmacy benefit managers. Brookings researchers weighed in on the possible consequences of the enactment of bipartisan legislation in Congress that would reform the way PBMs do business. The Journal reported on how health insurers that own PBMs make patients with cancer and other serious conditions pay thousands of dollars out of their own pockets for cheap generics. Read Full Article…

VBA Article Summary

1. Reassessment of Current Policies on PBMs: Brookings researchers are questioning the efficacy of bills under consideration by Congress that intend to ban practices such as spread pricing utilized by Pharmacy Benefit Managers (PBMs). They theorize that even if these practices are banned, PBMs might employ other strategies to maintain their profit margins, including possibly hiking administrative fees. They contextualize this debate within the larger market failure seen in the US health insurance landscape, indicating that the profit-seeking approach of the current system does not serve the best interests of patients or employers.

2. Monopoly and the Need for More Competition in the PBM Sector: The researchers propose that fostering more competition in the PBM space could be beneficial. The market currently is highly monopolized, with three companies controlling a significant share, thereby possessing the ability to garner excessive profits. While recent transparency proposals are seen as a step in the right direction, they might only have a moderate impact. They further note that completely eliminating profits from PBMs would reduce overall drug-related expenses by only a few percentage points, a scenario that seems promising from the patients' perspective, though not favored by PBM owning companies who are expected to fiercely defend the existing state of affairs.

3. High Markups on Generic Drugs and the Role of PBMs in Price Inflation: Highlighting the investigative piece by Joseph Walker, the article points to the massive markups on generic drugs, especially for treatments of serious conditions like cancer and multiple sclerosis. This mark-up strategy, which allows insurers and PBMs to charge exorbitantly for medications, significantly affects patients, who sometimes have to bear a part of these costs due to factors like deductibles or coinsurance linked to the price. Moreover, it is emphasized that PBMs are turning into substantial revenue generators for large for-profit insurers, overshadowing their earnings from health plans. The ongoing series promises to unveil more concerning trends in the industry, including practices that impose heavier financial burdens on patients and emerging transparent PBMs that are working to save considerable amounts for both employers and patients.

The transformative impact of telehealth and point-of-care on healthcare marketing

By Amit Phull, M.D. - Telehealth has gained widespread acceptance in recent years, and Doximity’s 2023 Telemedicine Report explores the broad application of telemedicine adoption among patients and physicians. The report found that physicians believe telehealth has enhanced continuity of care for patients, and patients state that telehealth has improved their access to healthcare services. Patients have embraced the convenience of accessing medical care from their home, eliminating time-consuming commutes and reducing exposure to contagious illnesses. Read Full Article…

VBA Article Summary

1. Transforming the Digital Point of Care:

   Pharmaceutical Marketing Evolution: The traditional model of pharmaceutical representatives personally interacting with physicians has significantly evolved. With over half of the U.S. physicians limiting access to pharmaceutical representatives, the industry is shifting towards a digital approach.

   Targeted and Data-Driven Strategies: The pharmaceutical industry is adapting by leveraging digital tools, targeted content, and data-driven approaches to reach healthcare professionals at the right time, facilitating a seamless flow of essential information that is more relevant and effective in influencing physicians' decisions.

2. Elevating Patient Care with Digitalized Education:

   Preference for Online Learning: A significant number of physicians show a preference for online platforms for staying updated with the latest research and developments. However, the time dedicated to reviewing this information is limited, indicating the need for concise yet impactful digital content.

   Enhancing Decision-Making with Actionable Information: The provision of brief, yet comprehensive, medical education digitally at the point of care not only aids physicians in informed decision-making but also enables them to effectively communicate complex medical concepts to their patients, thereby improving overall patient health and well-being.

3. Capturing the Attention of Healthcare Professionals at Key Moments:

   Integrating with Telehealth Platforms: Platforms such as Doximity are integrating targeted messaging features within telehealth tools, allowing brands to reach healthcare professionals effectively before and after patient visits, streamlining the information flow within the clinical workflow.

   Empowering Brands During Crucial Decisions: The telehealth advancements and new point-of-care tools offer brands an unprecedented opportunity to engage with healthcare providers at critical junctures in patient care, potentially revolutionizing healthcare marketing by enhancing patient-provider interactions and securing an exclusive share of voice in a fiercely competitive market.

The most popular benefits employees sign up for

By Sarah Oliver - The workplace benefits industry has experienced a noticeable shift since the days of the pandemic. While employers depend on their employees to reach their bottom line, employees are relying on their employers to reach their own, and they are making it known. In fact, in Prudential’s recent workplace study, 9 in 10 respondents indicated they expect their employer to play a role in their financial, mental, or physical wellbeing. Read Full Article…

VBA Article Summary

1. Diverse Needs for Different Generations: Employers need to recognize that different generations have distinct preferences and needs when it comes to benefits. Baby boomers and Gen X prioritize financial protections like Term Life and Disability. Millennials, given their life stage and debt situation, show interest in benefits such as student loan assistance and emergency savings plans. The emerging Gen Z workforce is leaning towards voluntary benefits, including pet insurance and mental health treatment plans.

2. The Importance of Personalized Enrollment Experiences: When open enrollment season approaches, many employees feel overwhelmed due to the plethora of options available. Employers can support their teams by offering personalized enrollment experiences that consider factors like generational differences and multicultural variations. For instance, translating enrollment experiences into different languages like Spanish could be beneficial. Moreover, integrating technology solutions, like Prudential's decision support tool, can assist employees in making well-informed decisions about their benefits.

3. Evolving Needs Require Active Listening: The era of a "one-size-fits-all" approach to employee benefits is becoming obsolete. As the workforce's composition changes, so do their needs and preferences. By providing what employees genuinely need, educating them adequately, and streamlining the benefits experience, employers can achieve higher levels of satisfaction among their teams. It's imperative for employers to actively listen to their employees' needs and stay updated with industry trends to ensure that they are offering the most appropriate and desired benefits.

LIMRA: Record number of Americans plan to purchase life insurance

By John Hilton - The life insurance story in the United States is some good news offset by a little bit of bad news. First, the bad news: Just 52% of U.S. adults report having life insurance, down from 63% in 2011, LIMRA reported. On the plus side, a record-high number of Americans (39%) say they plan to purchase life insurance this year. There was more good news than bad, according to new LIMRA data. Read Full Article…

VBA Article Summary

1. Growth and Performance in the Life Insurance Sector: Broad growth was observed in the insurance industry, with 60% of the carriers reporting an increase in premiums. Out of the top 10 carriers, eight experienced an average growth of 15%. In Q2 2023, the total U.S. life insurance new annualized premium reached $4 billion, marking a 1% rise. Whole life, term, and variable universal life insurance saw the highest premium growth rates.

2. Sales and Trends: Policy sales have been on the rise for two consecutive quarters. Q2 saw a 3% increase mainly attributed to indexed universal life products. Although new premium for indexed universal life decreased in Q2, the number of policies sold experienced a significant boost. Fixed universal life sales declined, and variable universal life sales accounted for just a 12% market share in Q2. However, term insurance sales, both in terms of premium and policy, surged, marking its best quarter in two years.

3. Market Insights and Outlook: An opinion survey highlighted the importance Americans place on life insurance. The first half of 2023 saw a new annualized premium of $7.7 billion, which was 3% lower compared to the same period in 2022. Whole life insurance remains dominant, holding 39% of the market share, while the number of Americans with term insurance policies has decreased over the past two decades, but the face value is increasing. LIMRA's survey, which covers 83% of the U.S. life insurance market, suggests an optimistic outlook for the rest of the year, backed by stronger economic conditions.

Providing employee benefits to independent contractors

By Bob Gaydos - The modern workforce is undergoing a significant transformation, with a surge in contract positions replacing traditional full-time roles. This shift has allowed companies to cut costs by not necessarily providing benefits to these contract workers, saving up to 25% on labor expenses. Read Full Article…

VBA Article Summary

1. The Necessity of Benefits for Gig Workers: Highlight the increasing reliance of several industries on gig workers, a section of the workforce that often lacks access to traditional benefits due to their contract status. Discuss the growing importance of attracting and retaining skilled independent contractors in the midst of a labor shortage. Emphasize the competitive advantage companies could gain by becoming early adopters of benefit programs tailored to these workers, thus making themselves more attractive employers in the burgeoning gig economy.

2. Overcoming Traditional Barriers to Benefits for Independent Contractors: Discuss the current limitations and challenges associated with providing benefits to gig workers, including their ineligibility for group insurance policies. Offer insights from your 30 years of experience in the benefits sector, proposing that a shift in focus from health insurance to other forms of coverage like life insurance, disability, and wellness programs could be a solution. Describe how this fresh approach can foster long-term relationships with gig workers and create a happier, more dedicated workforce.

3. Introduction to Lifestyle Accounts: A Revolutionary Approach to Benefits: Introduce lifestyle accounts as a novel, flexible solution that has emerged in recent years to address the benefit gaps faced by independent contractors. Explain how these accounts function, allowing workers to choose from a range of individual benefits based on a preset annual contribution from the employer. Highlight the potential tax implications for workers and how these are outweighed by the benefits offered. Discuss the broader implications of adopting lifestyle accounts, suggesting that extending this benefit structure to all employees, not just contractors, could enhance job satisfaction and foster talent retention in the long run.

Can AI Compose Clinical Documentation? Absolutely, but with Limits.

By Paul J. Posey, Jr. - A recent academic study of the leading LLM AI models’ ability to read and interpret clinical information demonstrates the incredible power of these tools to support healthcare, but concludes that LLMs should be used as “a supplement to existing workflows rather than as a replacement for human expertise." Read Full Article…

VBA Article Summary

1. The Need for Efficient Clinical Documentation: Clinical documentation plays a pivotal role in healthcare, serving functions like patient care, communication within the care team, billing support, and legal defense. Given its importance, clinicians often find themselves burdened with extensive documentation duties. A 2022 JAMA Internal Medicine report highlights that physicians spend nearly two extra hours daily on clinical documentation outside their office hours. This workload not only contributes to extended workdays but also exacerbates physician burnout, as highlighted by a 2022 New York Times report.

2. The Potential of LLM AI in Clinical Documentation: Large Language Models (LLM) like OpenAI’s ChatGPT have demonstrated advanced capabilities in generating coherent content across various domains, including medical. When integrated with Automatic Speech Recognition (ASR), LLM AI has the potential to revolutionize clinical documentation, potentially saving significant time for physicians. While the promise of LLM AI in this domain is vast, it should be viewed as a complementary tool to human expertise rather than a complete replacement.

3. Evaluating AI Solutions for Clinical Documentation: While AI offers promise in enhancing clinical documentation, it's vital for organizations to thoroughly evaluate potential AI solutions. Key considerations include the AI solution's integration capabilities with existing technologies, the quality and accuracy of AI-generated notes, its potential in enhancing billing and coding processes, and its ability to support physicians in producing high-quality notes in a fraction of the regular time. The rapid evolution of AI technologies necessitates careful selection to ensure the solutions not only meet clinical documentation needs but also contribute to significant time savings for physicians and staff.

List prices for Ozempic, Wegovy far higher in the US than in peer nations: KFF

By Paige Minemyer - It's not a secret that Americans pay far more than people living in other countries for drugs, and those data hold for trendy weight loss and diabetes treatments as demand for these therapies grows, according to a new analysis from KFF. Read Full Article…

VBA Article Summary

1. Significant Discrepancies in Drug Pricing Across Countries: The research has highlighted a substantial disparity in the pricing of four prominent products—Ozempic, Wegovy, Rybelsus, and Mounjaro—in the U.S market compared to other countries. For instance, the U.S list price for Wegovy stands at $1,349, a stark contrast to $328 in the Netherlands and $296 in Sweden. A similar trend is observed for the other products, with a one-month supply of Ozempic priced at $936 in the U.S, whereas it is available for as low as $83 in France. The differential pricing makes these drugs considerably less accessible in the U.S., potentially impacting how insurers cover them and affecting the overall health spending.

2. Increased Off-Label Use and Potential Supply Shortages: The report notes that the escalating off-label use of these drugs is inducing supply shortages, notably for diabetes patients. This surge in demand is causing scrutiny from employer health plans and insurers, influencing the prescribing patterns of these drugs. The pricing strategy adopted for these drugs will determine their accessibility to patients, potentially affecting the coverage provided by insurers and, consequently, the general health expenditure.

3. Obesity Prevalence and Interest in Prescription Weight Loss Drugs in the U.S.: The United States witnesses the highest obesity rates globally, with a prevalence rate of 33.5%, significantly higher than the next country, the U.K., at 25.9%. This trend, coupled with a growing interest in prescription weight loss drugs—where half of the U.S. adults have shown willingness to try them—indicates a potential spike in the use of these therapies. However, the interest may decline if insurance does not cover these products. Furthermore, the potential long-term regimen requirements and unresolved concerns about certain side effects may inflate costs further, considering the already high pricing of these drugs. This scenario hints at a possibly more substantial impact on the U.S. health spending compared to other countries.

Distracted Employees Cost More Than Sick Ones

By Charles R. Chaffin Ed.D. – Your organization is distracted. Research suggests that knowledge workers lose 2-3 hours per workday to distractions, and yes, this lack of focus is expensive. Workforce distraction has been estimated to cost organizations 14-to-15 times more than health-related absenteeism. Read Full Article…

VBA Article Summary

1. Optimize Communication Strategies: Executive leaders must steer their teams away from the constant deluge of emails which can sap productivity and increase stress levels. Encouraging face-to-face communication or video conferencing can be more effective in driving actions. Instituting email "quiet periods" and modeling responsible email usage by senior staff can help in reducing reliance on inboxes, thereby promoting better focus and productivity among team members.

2. Revamp the Office Layout: The open-plan office, despite its intentions to foster collaboration, has significantly reduced face-to-face interactions and employee satisfaction due to the heightened noise levels and lack of privacy. To counter these issues, organizations should consider redesigning the workspace to allow employees access to quiet, private spaces. This will aid in minimizing distractions and stress caused by a noisy environment and enhance concentration and productivity.

3. Foster a Respectful Work Environment: Maintaining a respectful and emotionally healthy workspace is vital to not only retain employees but also to enhance their productivity. Incidents of rude or disrespectful behavior can be highly distracting, impacting workers' memory capacity, creativity, and decision-making skills. Leaders should prioritize creating a respectful workplace culture to mitigate distractions and enhance employees' focus and efficiency in performing their tasks.