Health Insurance Industry Issues and Legislation

Armed with new research that nearly 6 in 10 patients taking GLP-1 medications don't reach a meaningful health benefit, more insurers are turning/returning to Bariatric Surgery to treat diabetic and obese patients. They are decreasing barriers for bariatric surgery increasing them for coverage of expensive GLP-1 medications. Presently, about one third of employer-sponsored plans are covering GLP-1 for diabetes and obesity while almost two-thirds include bariatric surgery in their plans.

Drafts of electronic health record messages to patients created by generative AI were of similar quality and accuracy as the those written by healthcare professionals. Additionally, usable AI drafts were rated more empathetic than usable drafts from humans according to a new study. The findings suggest that chatbots could reduce workloads for care providers while meeting patients' needs for timely information and providing a more positive experience.

AI can assist in analyzing data, providing information, and making recommendation. However, it takes real people, like HHC's Attorney negotiators, to determine the true value of healthcare claims, identify, reach, and engage provider decision makers in nuanced negotiations, and secure agreements as to the amount the provider will accept for the services provided. Real people using their experience, expertise, and knowledge to maximize payor savings.

Commercial healthcare spending is expected to grow by 8% in 2025, the highest level in 13 years and a full percent higher than 2024. Primary drivers of the increase include inflationary pressures, surging spending for prescription drugs - including expensive weight loss drugs, specialty drugs, and gene therapies – and rising utilization of behavioral healthcare. Trends likely to reduce costs include the expanded use of biosimilars and more holistic cost management by insurers.