2024 Convention Highlights: Specialty-drug Impacts, SDOH and Aging, Understanding Generations and the Return of Bowling
I would love it if everyone reading this had been with us for the 2024 Annual Convention & Trade Show in mid-September, simply because those 28 hours were so packed with insight, expertise and good company that I hate for anyone to have missed it. But since I know not everyone could be there, I’ll share some highlights.
On the fun front, I think I’m safe in declaring that the invitation-only bowling event, in its second year this year, is now an annual tradition. Our plan members are a hardworking and competitive bunch who also like to have fun, and there seems to be something about a 10-pin competition that brings this out in all the best ways.
For the convention, we aim every year to assemble a lineup of speakers and presentations that hit on the hottest current healthcare topics and this year was no exception. On the menu this year were the specialty-drug challenge, generational considerations in the workplace and external marketing, social drivers of health among older populations, emerging AI use, and healthcare policy and politics.
The unsurprising bad news about emerging specialty drugs, including gene therapies, is that more and more hyper-costly options are coming, and we have an industry model ill-equipped to accommodate them. The good news is that the market is responding with solutions for payers and self-insured employers, but there’s still a lot to be learned.
Gene therapies present a particularly challenging misalignment: We’re accustomed to paying for medication therapies on a per-patient-per-month basis, spread over a period of time during which the patient takes the drug. But many gene therapies, in addition to carrying costs well north of $1 million, are “one-and-done” — administered just once. Drug pricing analyst Antonio Ciaccia posed the rhetorical question, “You are operating quarter by quarter, in the short term. How can you accommodate these drugs that are in complete misalignment with your model?”
Mikal Jeffries, vice president and senior benefit consultant with HUB | HORAN, said that arriving at the right answer for what to cover and how depends on companies carefully analyzing a host of factors such as the demographics of their employees, how much they can spend on healthcare and the likelihood that an ultra-expensive claim will hit. The calculation is complicated by the fact that employees today stay in jobs an average of only three years.
The task is to balance cost vs. company culture, Jeffries said, and the difficulty of that task is reflected in how much time he spends talking with clients about the pharmacy portion of their healthcare spend. It used to take up about 15 minutes of an hour-long meeting, with medical coverage taking up the rest. “That’s completely flipped,” Jeffries said. “The environment has changed drastically in five years.”
While claims for budget-busting gene therapies remain very rare, most insurers are seeing a “tidal wave” of demand for GLP-1 drugs for Type 2 diabetes and weight loss — not in the million-dollar range, but nonetheless costly and having a heavy impact on healthcare spending. A key challenge as Jeffries sees it is to set up “guardrails” to ensure the therapy is appropriate and is properly attributed to a diabetes diagnosis or for weight loss. As with so much in the fast-changing healthcare landscape, we have a lot more to learn about GLP-1s and whether their cost is justified by improved patient outcomes.
The conference also featured a fascinating talk by Robert Applebaum and Suzanne Kunkel, researchers with the Scripps Gerontology Center, who focused on social drivers of health as they apply to aging patients. It offered an in-depth look at this population that is increasingly important to healthcare plan design. I believe their insights will be especially helpful to our member plans with the coming expansion of MyCare, the state program designed to serve those who qualify for both Medicaid and Medicare.
Mark Taylor, a dynamite speaker on the implications of generational differences for organizations, really got us thinking about how understanding the distinctions between generations can be helpful both internally and externally.
Knowing how to talk to the different generations and understanding what’s important to them helps us as employers to attract and retain good workers, but it’s also important for us in relation to our plan members. Say we’re encouraging baby boomers to get protected with the RSV vaccine; that messaging is likely to be quite different from an effort to 18-50-year-olds to get the COVID vaccine.
My table had Gen-Xers (including me), someone on the Gen X/millennial cusp and a solid millennial, and we all thought Taylor’s observations were spot-on.
I could talk about lots more from the convention, including the always great media panel and a look at the risks and rewards of emerging AI technology in healthcare, but I know we’re all busy folks with lots on our plate. In fact, that’s exactly why we keep our event to a day and a half and pack it full of as much value for attendees as we can manage. I hope you’ll consider attending next year, and in the meantime I hope you enjoy the array of original stories and curated news that we publish regularly on our website, social media and in our OAHP quarterly newsletter (subscribe here).
