Humana Leaves Employer Insurance Market

Humana has decided to leave the employer insurance market and focus instead on its government programs including its Medicare Advantage plans and specialty segments. Humana’s Medicare Advantage plans increased this year and are expected to continue to rise prompting the company to focus its resources on increasing that line of business.

In 2021, Humana reported that just $7 billion of its total revenue of $83 billion came from the business sector. While employer insurance was never the core of Humana’s business, leadership decided to focus solely on the more profitable areas of business including the Tricare military contract and other government-backed programs.

SOURCE: Reuters


Patients Uneasy with AI

Artificial Intelligence (AI) is becoming more commonplace in all industries, including healthcare. However, a recent study from the Pew Research Center revealed that six in 10 adults would be uncomfortable if their healthcare provider used AI to help diagnose them or recommend treatments.

AI may be used to help providers make fewer mistakes. Patients were surveyed and while most were okay with using AI for skin cancer screenings, many still had reservations about using it for mental health, pain management, and surgery. A potential benefit of using AI in healthcare is a possible reduction in racial and ethnic bias. However, concern over the security of health information and privacy was a potential con for patients.

Those who were more open to the idea of using AI in healthcare were younger people, and those with higher education. However, when broken out by gender, 54% of men said they would be uncomfortable with AI in healthcare, versus 66% of women.

AI will continue to affect every aspect of our society, and healthcare will be included, in one way or another.



Top Self-Insured Employer Concerns

The Midwest Business Group on Health (MBGH) conducted a survey that determined that self-insured employers “view the cost of specialty drugs as a major challenge in providing health care benefits.” As the FDA has approved some million-dollar treatments for various conditions, employers are concerned they won’t be able to cover the costs.

MBGH is made up of self-insured employers who overall provide benefits to more than 4 million people and spend about $15 billion each year in healthcare costs. Employers who were surveyed want to steer beneficiaries to lower-cost alternatives for medication as well as more transparency in contracts with pharmacy benefits managers. Another top concern is compliance with the Consolidated Appropriations Act (CAA) which requires self-insured employers to have fiduciary responsibility for the benefits they offer.

A majority of employers surveyed also believed that hospital pricing was unreasonable and a concern. In addition, most of those surveyed believe that market consolidation has not improved the cost or quality of services.

SOURCE: Fierce Healthcare


Eli Lilly Caps Insulin Costs

After a lawsuit from the state of California, pharmaceutical company Eli Lilly reduced the cost of its insulin products by 70%, expanded its Insulin Value Program, and capped insulin costs at $35 or less for patients. Insulin prices in the past several years have skyrocketed. A 2018 study conducted by JAMA found insulin prices had risen 197% between 2002 and 2013 after adjusting for inflation.

Insulin caps at $35 were already in place for those who utilize Medicare, and Eli Lilly said in a press release that extending that cap to those with commercial insurance was the right next step. Eli Lilly isn’t the only pharmaceutical company that produces insulin, and its leadership is calling on other companies to follow its lead.



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