Huge decline in spending on Medicare begs the question: Why?

By Frank Diamond - Research shows that Medicare spending has leveled off for the past decade, morphing from something that experts worried might break the federal budget to an unexpected bright spot. The New York Times spotlighted this trend in an article this week, digging into a 2019 Health Affairs study co-authored by David M. Cutler, Ph.D., an economist at Harvard University and one of the main architects of the Affordable Care Act (ACA). Read Full Article…

VBA Article Summary

1. Medicare Spending Slowdown & Federal Impact: Initially, there was debate on whether the spending slowdown was temporary, potentially due to the Great Recession. Although this theory has been largely disproven, the exact reasons for the spending slowdown remain partially uncertain. If the earlier predicted spending on Medicare had continued, the New York Times estimates the federal spending might have been higher by $3.9 trillion since 2011. This would have made the federal deficits more than a quarter larger. The Affordable Care Act (ACA) and the reduction in acute cardiovascular events (56% decrease in hospital admissions for ischemic heart disease and 41% decrease for stroke since 1999) are some contributing factors to this slowdown.

2. CBO's Projections & Analysis: The Congressional Budget Office (CBO) admitted overestimating Medicare spending in its earlier forecasts. Most of this overestimation came from the spending per beneficiary rather than the number of beneficiaries. Major errors in the CBO's 2010 projections came from unexpected drops in Medicare Part D prescription drug spending and Medicaid's long-term services and supports. Paul B. Ginsburg, formerly of the CBO, explained that while some factors behind the Medicare spending slowdown are understood (like preventive care leading to improved cardiovascular health), others remain a mystery.

3. Medicare Advantage (MA) Plans and the Slowdown: Ginsburg emphasized the potential impact of the spending slowdown on Medicare Advantage (MA) plans, suggesting they may have considerably benefited from these trends. MA plans might have increased their emphasis on preventive care to combat cardiovascular diseases and subsequently reaped the benefits of reduced treatment costs. Another advantage for MA plans is the slowdown in Medicare spending growth, which has lessened the urgency for policymakers to enact aggressive cost containment measures. However, Ginsburg notes that while these benefits were evident in the past, their continuation in the future remains uncertain.

Views How to ensure your company makes the most of its benefits dollars

By J.R. Clark - Record-setting inflation and general economic uncertainty are causing everyone to exercise caution, including employers. Although some experts suggest the "great resignation" has subsided, the number of Americans who quit their jobs actually accelerated in late 2022. People are leaving their jobs in search of things like better pay, more flexible work arrangements, and increased vacation time. Read Full Article…

VBA Article Summary

1. Evolving Employee Priorities: As the job market becomes more competitive, employees are focusing more on benefits that improve their overall health and well-being. While traditional compensation and advancement opportunities remain essential, workers prioritize flexible schedules, remote work, retirement contributions, mental health coverage, and wellness stipends. To retain talent, companies need to be proactive in assessing and updating their benefits packages in response to these changing priorities.

2. Optimizing Benefit Solutions: With an array of health and wellness vendors available to employers, it's crucial to ensure the benefits provided are utilized and appreciated by employees. Regular assessment of benefit utilization, eliminating redundancies in offerings, and actively seeking feedback from employees can help HR leaders craft benefit packages that truly meet employee needs and desires.

3. Financial Tools for Healthcare: Given the rise in healthcare costs and the potential financial strain on employees, employers should consider providing tools to help cover these costs. Solutions such as Health Savings Accounts or Health Payment Accounts can assist employees in managing out-of-pocket expenses, making healthcare more accessible and less burdensome.

Integrating Workers’ Comp and Medical Benefits Makes So Much Sense

By Michelle Zettergren - Workers’ compensation programs and health insurance plans have traditionally existed in separate lanes. Workers’ comp, which covers work-related injuries or illnesses, is a legal requirement of the employer in most states. Conversely, health insurance covers non-work-related injuries and illnesses, is not required by law in most states, and whether or not it’s offered can vary greatly based on the size of the firm and the state in which it operates. Read Full Article…

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1. Need for Integration of Workers' Comp and Medical Benefits Programs: The existing dual-system model for medical care and workers' compensation is characterized by inefficiency, high costs, and inconvenience for employees. There's a pressing necessity to amalgamate these programs to ensure streamlined processes, better transparency, and substantial time and cost savings. Integrating the two systems can foster preventive care and disease management under one roof, potentially reducing bureaucratic bottlenecks and promoting quicker recovery and return to work for the members. Both unions and employers stand to gain from this integration, with possibilities of expanding benefits and bolstering the financial position of unions.

2. Collaboration between Unions and Employers: Over the years, there has been a growing acknowledgment of the adversarial potential and slowness of the state-supported workers' comp system. Increasingly, unions and employers are exploring opportunities to collaborate on integrated options that offer a seamless experience for members, providing rapid access to high-quality medical and rehabilitative services. This collaborative effort aims at developing medically directed guidance systems that facilitate members' quicker return to health and work, a feature lacking in many current workers' comp programs. Implementing an integrated system could lead to synergized outcomes including increased efficiency, reduced costs, and heightened transparency, offering substantial benefits for all stakeholders involved.

3. Navigating Obstacles to Integration through Strategic Partnerships: Despite the clear advantages of integration, there exist significant barriers, predominantly arising from variations in state laws that govern workers' comp arrangements. These laws create a complex landscape with differing legal stipulations concerning workers' comp claims management and the possibilities for self-insurance. To navigate these challenges, third-party administrators (TPAs) and Preferred Provider Organizations (PPO) networks can play a vital role in spearheading compliant plans and negotiating with providers. Furthermore, exploring innovative solutions like union-based captive solutions can potentially serve as a viable route to facilitate self-insured workers' comp programs, even in states with restrictive policies. Through these strategies, employers and unions can join forces to devise their programs, select vendors, and manage risks more effectively, transforming the existing system into a cohesive nexus that promotes swift recovery and return to work for employees.

New Report: 68.5 Million Adults in the US Don’t Have Dental Insurance, May Rise to 91.4 Million by End of Year

By Business Wire - An estimated 68.5 million adults in the United States do not have dental insurance, according to new data released today by CareQuest Institute for Oral Health®. This data, which comes from the third annual State of Oral Health Equity in America (SOHEA) survey, also reveals that the number of adults without dental coverage could rise significantly by the end of 2023 due to additional household members losing coverage and the Medicaid redetermination process. Read Full Article…

VBA Article Summary

1. Soaring Number of Uninsured Adults: The article highlights a critical increase in the number of uninsured adults in the US, with a potential rise to 91.4 million individuals without dental insurance by the end of this year. This alarming figure is due to a combination of losses in household coverage and potential terminations of Medicaid dental insurance coverage following the expiration of the public health emergency. It underscores a growing oral health crisis where a significant portion of the population may forgo essential dental care, which disproportionately affects low-income groups and racial and ethnic minorities.

2. Inequities in Existing Government Programs: The CareQuest Institute for Oral Health has noted the discrepancies in dental coverage provided by government programs like Medicaid and Medicare. These platforms currently offer limited, inconsistent, or no dental benefits for adults, which varies significantly from state to state. To address this issue, the Institute calls for comprehensive reforms to these programs to ensure that all enrollees have access to extensive dental benefits, emphasizing the necessity of including these enhancements in both Medicaid and Medicare to mitigate the existing disparities in oral health coverage.

3. Demographic Disparities and Barriers to Access: The 2023 SOHEA survey administered by the CareQuest Institute revealed glaring disparities in dental insurance coverage across various demographic groups. These discrepancies are observable in different geographical regions and among different racial and ethnic groups. Notably, Hispanic individuals are twice as likely to lose dental insurance compared to white non-Hispanic individuals, and adults living in rural areas are more likely to lack dental coverage than those in urban or suburban areas. Moreover, the survey found that financial barriers have prevented a significant number of lower-income adults from visiting a dentist in the last two years. Through this research, the Institute aims to shed light on these challenges and propel actions to foster oral health equity in the country.

US Prescription Drug Costs More Than Double Those in Canada

By Emma Bardin - The high price of prescription drugs isn’t just hitting patients in the pocketbook. Non-adherence, often driven by high prices, costs the healthcare system between $100 billion and $290 billion every year, according to a review of studies by Annals of Internal Medicine (AIM). That same review found that of the medications prescribed, between 20% and 30% of them are never filled by patients. Read Full Article… 

VBA Article Summary

1. Soaring Prescription Medication Costs in the U.S. and the Burden on Patients: Physicians are limited in their ability to alleviate the financial strain of medication costs on their patients, often constrained to prescribing generic versions or the most cost-effective option among similar therapies. Unfortunately, many patients find themselves having to ration medication, endure financial hardship, or even skip doses due to exorbitant costs. This problem has driven a considerable number of U.S. patients to seek more affordable alternatives in neighboring Canada, where drug prices are regulated and significantly lower, reducing the price gap up to 90%.

2. Canadian Companies Addressing the Affordability Crisis: Recognizing the burgeoning demand for affordable medication, several companies have emerged to facilitate the procurement of prescription drugs from Canada. Companies like Pharma Giant and Buy Canadian Insulin, both established in 2020, have been instrumental in helping U.S. patients find cost-effective solutions for their medication needs. Offering a vast range of medicines, including treatments for diabetes, arthritis, blood pressure, cancer, and allergies, these companies provide options that can potentially save patients thousands of dollars on their prescriptions, even offering express shipping services to ensure timely delivery.

3. Comparative Analysis of Drug Prices and the Potential Savings for Patients: A closer look at the numbers unveils the staggering price disparities between prescription medications in the U.S. and Canada. For instance, Trulicity, a medication used for type 2 diabetes, costs $1,117 in the U.S. as opposed to $282 in Canada. Similarly, Rinvoq, a medication used to treat Crohn’s Disease and Ulcerative Colitis, is priced at $11,915 stateside, nearly seven times the Canadian price of $1,749.95. These price gaps extend to several other critical medications, offering substantial savings for patients who choose to purchase from Canada. Furthermore, buying from Canada can sometimes mean access to medications that are currently out of stock in the U.S., thus providing not only a more affordable but also a more reliable solution for patients.

5 Ways To Balance Mental Health While Working Remotely

By Goldie Chan - Remote work sounds like a dream come true for most employees. No more sitting in traffic, you can roll out of bed 30 minutes before starting your day, you get to spend more time with your family, and you don’t have a manager peering over your shoulder. Although the delights of working from home are many, according to experts, it’s causing more harm than good. In Microsoft’s 2022 New Future of Work Report, researchers discovered that while remote work has led to an increase in job satisfaction, it’s also causing employees to feel guilty about not doing enough and socially isolated. Read Full Article…

VBA Article Summary

1. Opt for a Different Work Setting: The article emphasizes the importance of creating a clear boundary between one's work life and personal life to mitigate the negative aspects of remote working such as isolation and poor work-life balance. To achieve this, it suggests opting to work from places like co-working spaces, libraries, or coffee shops instead of working from home.

2. Maintaining Physical and Mental Well-being: The article highlights the negative health consequences of remaining sedentary for extended periods, a common occurrence in remote work settings. It advocates for regular walks as a method to not only break the monotony but to enhance one's mood, decrease stress and anxiety, and boost energy levels, thereby promoting both physical and mental well-being.

3. Effective Time Management to Prevent Burnout: Stressing the dangers of overworking while at home, the article outlines the various repercussions on mental health. It suggests avoiding working overtime to prevent feelings of isolation, increased screen time, and an inability to disconnect from work. Moreover, it urges individuals to maintain a clear division between work tasks and household chores to prevent added stress, along with advocating for regular breaks to break the day into manageable chunks and avoid burnout.

Navigating Medicare’s evolving landscape in 2023

By Al Kushner - The Medicare landscape is continuously evolving. As we navigate these changes, it's essential to stay informed about the latest news and updates that could impact providers and beneficiaries. One significant development this year is the new rule from the Centers for Medicare and Medicaid Services aimed at promoting high-quality care. This rule rewards hospitals that deliver efficient and effective services, marking a shift towards value-based health care. Read Full Article…

VBA Article Summary

1. Controversies and Challenges in Treatment Coverage: Certain insurers are refusing coverage for a new Alzheimer's treatment for specific customers, igniting a debate about the cost-effectiveness of new drugs. A monumental Medicare fraud case in Maine stresses the importance of vigilant oversight to prevent misuse of funds. The potential increase in Medicare Part B premiums in 2024, partially attributed to the new Alzheimer's drug, emphasizes the challenges of balancing coverage expansion with cost management.

2. Positive Developments and Policy Shifts: CMS introduces a cap on the cost of a one-month supply of Part B-covered insulin at $35, benefiting many diabetes patients. There's been a noticeable shift in Medicare Advantage enrollment, with states like New Jersey, Maryland, and West Virginia witnessing significant increases.

3. The Evolving Landscape of Medicare: The ongoing emergence of new treatments, policy alterations, and demographic changes means Medicare will persistently transform. Staying updated on these shifts is vital for effectively navigating the intricate Medicare system.

LIMRA: Improving Economic Conditions Buoy Second Quarter U.S. Life Insurance Sales

By LIMRA - Total U.S. life insurance new annualized premium was $4 billion in the second quarter 2023, a 1% increase, according to final results from LIMRA’s Second Quarter U.S. Retail Individual Life Insurance Sales survey. For the first half of the year, new annualized premium was $7.7 billion, 3% below the same period in 2022. Read Full Article… 

VBA Article Summary

1. A Significant Rise in Premiums: In recent findings by LIMRA, the life insurance industry has observed a significant uptick, with approximately 60% of carriers reporting a growth in premiums. Notably, eight of the top ten carriers experienced an impressive average growth of 15%. This growth has been predominantly driven by high premium growth rates in whole life, term, and variable universal life insurance policies. Karen Terry, head of LIMRA Product Research, anticipates this positive trend to persist into the latter half of the year, stimulated by increasingly favorable economic conditions.

2. Consistent Increase in Policy Sales: The life insurance industry has also seen a steady increase in policy sales, marking the second quarter in a row with a growth in this area. In the second quarter, sales grew by 3%, a boost attributed mainly to the success of indexed universal life products. Overall, the first half of the year witnessed a 4% rise in policy sales compared to the same period in 2022, indicating a consistent upward trend.

3. LIMRA as a Trusted Source for Industry Insights: For over a century, LIMRA has served as a reputable source for data and insights into the U.S. life insurance market, with its Retail Individual Life Insurance Sales Survey representing 83% of the market. The organization's extensive and long-standing history, dating back to 1921, underscores its position as a trusted resource for accurate data and trending analyses in the industry. For more in-depth information on this quarter's sales results, interested parties are directed to the recent publication on the "Second Quarter 2023 U.S. Life Insurance Industry Estimates" available in LIMRA’s Fact Tank.