Healthcare Watch April 2023

Patient Pages: How Healthcare Costs Affect Insured Patients Today

A new study shows an insured American with an employer-sponsored health insurance plan can expect to spend more than $320,000 (including insurance premiums and out-of-pocket costs) during his/her adult lifetime. This amount could reach $700,000 for Americans who purchase their own insurance or suffer from chronic illnesses.

The Synchrony Lifetime of Healthcare Costs study included 3,200 research subjects who incurred on average $5,266 of annual individual healthcare costs that included insurance premiums, out-of-pocket expenses, and co-insurance deductibles, which extrapolates to an estimated $320,000 in individual healthcare costs between the ages of 18 and 79. Furthermore, many people underestimate their healthcare costs and do not save enough for annual expenditures, often leading to delays in treatment that can be detrimental to the patient. More than one in four respondents said they have delayed a recommended procedure due to cost with nearly 20% ignoring the recommended care completely. Of those who delayed or ignored the recommended care, nearly 50% said it caused additional medical issues.

“Today’s consumers set aside money for college or a mortgage, but not for healthcare. As a leader in patient financing, we believe it is important to build awareness among consumers of the cost of healthcare over a lifetime, so they think about and prepare for how to save and pay for their current and future healthcare needs,” said Alberto Casellas, Chief Executive Officer, Health and Wellness, Synchrony. “The study shows there is a meaningful gap between people’s perceptions and the reality of the costs of healthcare. As consumers assume more and more responsibility for their healthcare expenses, it is important to understand the cost of care and how to find responsible financial solutions that can help them save for and manage those costs.”

Those who pay for their own insurance or who have ongoing medical issues such as diabetes, heart disease, or cancer, would have to save much more annually. But there are differences in healthcare affordability between ages as well. The study finds that half of Gen Z, Millennials, and Gen X individuals would hold off non-urgent medical treatment if the cost of care was between $500 and $999 as compared to approximately 33% of Boomers. Additionally, 65% of Millennials and 60% of Gen X patients reported they were not financially prepared for their most costly out-of-pocket healthcare expense while 40% of Boomers and 23% of those over 78 years of age reported the same. Finally, fewer than half of all the respondents are actually saving for healthcare costs and of those who are, 55% believe they won’t be able to cover those expenses.

Med Device Department: Medicare Sets Precedent for Virtual Reality Therapeutic Payments

In November 2021, the FDA approved a virtual reality (VR) therapy that provides an immersive experience for relieving chronic lower back pain. Now, the Centers for Medicare & Medicaid Services (CMS) named RelieVRx a durable medical device and made it the first immersive therapeutic to be included in an existing benefit category. CMS will be determining the price for the device next, which consists of a VR headset and software. Now that Medicare covers the therapy, manufacturer AppliedVR hopes that commercial health plans, self-insured employers, and other payers will consider covering the program. CMS factored in the efficacy of the device as well as its safety beyond the use of opioids.

Matthew Stoudt, AppliedVR’s Co-founder and CEO explained, “We are building an unparalleled body of data that demonstrates both the efficacy of what we’re doing as well as the value of what we’re creating here for the patients. Because we believe fundamentally that that’s ultimately how you’re going to get all the different payers on board.”

CMS has approved the device to be used at home for an eight-week treatment course that includes cognitive behavioral therapy including modules on pain education, breathing practices, pain distraction, and mindfulness, which activate five regions of the brain and engages multiple neural systems. With Medicare paving the way for VR therapy coverage, payers will have to consider coverage of FDA-approved immersive therapies as safer alternatives to painkillers and surgeries.

Doctor Docs: HCPs Are Still Burnt Out But Remain Hopeful About Pricing

Headshot of Daniel S. Fitzgerald the CEO and President of Apollo Intelligence.
Daniel S. Fitzgerald, CEO and President, Apollo Intelligence.

HCPs worldwide are still feeling the staffing shortages, burn out, and salary effects from the COVID-19 pandemic. Apollo Intelligence’s Global Healthcare Predictions Report found that U.S. physicians are reporting feeling even more burnout (49%) in 2023 than they were in 2022 (45%). Most are concerned about the continuing staffing shortages (70%) while many believe (60%) that HCPs will continue to leave their profession as their outlook on the healthcare situation becomes increasingly bleak.

Doctors worldwide remain largely resigned to a status quo that will deliver more of the same. One in three (33%) U.S. physicians have considered leaving the profession, and physicians in all nations express frustration over their lack of compensation, the way they are treated, and their place in the decision-making process. While 20% of U.S. HCPs would like improved pay, only 6% think it will happen.

“Physicians remain frustrated, burned out, and concerned about their patients and their profession. Yet there is a greater belief that they’ll see improvements that they’ve wanted for years around pricing, patient access, and innovation,” said Daniel S. Fitzgerald, CEO and President of Apollo. “Apollo’s report shares the voice of the clinician in the hopes that their insights will help industry leaders to address long-standing healthcare challenges that have a profound impact on society.”

However, physicians are optimistic when it comes to healthcare pricing. In the U.S., about 20% of doctors believe that drug prices will rise in the next year. But 13% predict costs will get lower, compared to only 7% believing costs will lower in 2022, which may represent a meaningful change.

Meanwhile, 11% of HCP respondents in the U.S. hope for regulatory change while 10% realistically think it will occur. This is coupled with concern over the FDA’s slowdown in drug approvals; 45% of physicians report barriers to treating patients as a result and 18% report resorting to using older, less effective treatments for some patients.

FDA Update

Drug Approvals

The FDA has approved the first treatment for Activated PI3K-delta syndrome (APDS), a genetic disorder that causes low numbers of white blood cells, particularly certain types of B cells and T cells, compromising the immune system. Pharming’s Joenja (leniolisib) tablets, intended for patients 12 years and older, work by increasing B cells to combat symptoms of APDS, which include recurrent infections, particularly in the sinuses, ears, and respiratory tract. Patients also develop enlarged lymph nodes, tonsils, and other organs that can cause obstruction in the airway and gastrointestinal tract and are more prone to develop blood cell cancers, such as lymphoma. Trials show a reduction of lymph node size and increase in B cells in patients after 85 days.

The first treatment for Rhett Syndrome, a rare, genetic disorder, has been FDA approved. Daybue (trofinetide), an oral solution made by Acadia Pharmaceuticals, shows improved development and reduced symptoms of Rett Syndrome in patients 5 to 20 years of age. Rett Syndrome affects brain development, and cause patients to start losing motor and language skills at around 6 months of age, affecting the ability to eat, walk, speak, and breathe. It occurs in one out of every 10,000 females and more rarely affects men.

Med Device Approvals

Convatec received approval for its InnovaBurn placental extracellular matrix medical device for management of complex surgical wounds and burns, including partial-thickness second-degree burns. The InnovaBurn medical device joins Convatec’s InnovaMatrix platform as the first and only placental-derived medical devices designed for management of burns, complex surgical wounds, and hard-to-heal wounds.

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