September 26, 2023

Happy Tuesday, Vitals crew. Maya's back today and steering the ship solo for the rest of the week.

Today's newsletter is 1,163 words or a 4.5-minute read.

1 big thing: Employers drill down on perks

Illustration: Shoshana Gordon/Axios

Employers bracing for a major hike in health costs are retooling their benefits, aiming to provide perks like menopause support or beefed-up mental health options targeted to workers' needs as they closely mind the bottom line, Axios' Tina Reed writes.

Why it matters: Employer health costs are expected to see their largest jump in a decade, but many companies facing an ongoing workforce crunch are hesitant to pass along those costs or cut back benefits.

  • Rather than adding on a host of new benefits to remain competitive, employers are trying to shore up care gaps while also keeping a lid on costs, experts say.

What they're saying: "In the past, especially with COVID, there may have been a proliferation of, 'Let's offer all of these services,'" said Ashok Subramanian, CEO of health plan administrator Centivo.

  • "Now employers are asking: How do we avoid having to change our 401(k) match because of health care?"

Here's what experts are watching for during this fall's benefits season:

  • Better mental health options: Recognizing the shortage of mental health professionals, employers have added supplemental provider networks, often through virtual offerings like Ginger or Teladoc, said Mercer researcher Beth Umland.
  • Menopause support: While there's been a lot of focus on supporting reproductive-age women through fertility, pregnancy and lactation services, there's growing recognition around menopause.
    • In many cases, the support offered isn't complicated or expensive — it may be more days off or ensuring access to specialists. But there's greater focus on removing stigma and barriers for those seeking care.
  • Inclusive benefits: Employers have placed greater emphasis on addressing equity. For instance, employers are taking a closer look at provider networks to ensure they reach underserved populations and neighborhoods.
  • Health-adjacent perks: A newer tool is a lifestyle spending account, which could be used for gym memberships or even items unrelated to health care, such as home office renovations.

Go deeper

2. Women's higher health costs

Average out-of-pocket medical spend, by age
Reproduced from Deloitte; Chart: Axios Visuals

Women at every age have higher out-of-pocket expenses for their health care than men despite having similar health insurance, Tina writes on a new Deloitte report.

Why it matters: Much has been made about a so-called "pink tax" when it comes to higher costs for women's consumer products. The new analysis argues there's a similar burden when it comes to women's health coverage.

By the numbers: Even when removing maternity care from the equation, women each year are paying $15.4 billion more out of pocket for health care, according to Deloitte's actuarial analysis of more than 16 million people who have employer-sponsored coverage.

Between the lines: Women use health care more often, with 10% more in total health expenditures relative to men. But they still saw out-of-pocket expenditures that were 18% higher after removing maternity costs, the authors wrote.

  • The authors said this may be partly explained by the different kinds of care recommended for women, such as earlier annual checkups and gynecological examinations.
  • They also cited the relatively high cost of breast cancer imaging compared to screening for other cancer types, and costs associated with the effects of menopausal transitions.
  • They also recommend employers consider increased spending — an estimated $133 per enrolled employee annually — to create financial equity in their health care benefit.

Share this story

3. Harsh review for ALS therapy

Illustration: Eniola Odetunde/Axios

Food and Drug Administration staff reviewers issued a critical assessment of an application BrainStorm Cell Therapeutics filed for its experimental ALS therapy, registering "major concerns" that the company's evidence falls short of the agency's approval standards.

Context: The company's application for an experimental stem-cell therapy aimed at slowing progression of the fatal neurodegenerative disease was turned away by the FDA last year because the company's submission was "scientifically incomplete and grossly deficient," along with other "critical clinical and manufacturing deficiencies," noted FDA documents posted Monday.

  • The company then filed the application in protest, with new retrospective analyses and biomarker data.
  • An advisory committee will consider the application for the treatment, NurOwn, on Wednesday during a meeting that will be closely watched by patient advocates, who have urged the agency to back the treatments.

Catch up quick: The FDA in the last year has given accelerated approvals for two ALS treatments, including the first one based on biomarker results, and the agency has pledged regulatory flexibility in the search for treatments.

  • Still, agency reviewers on Monday were unmoved by the company's new analyses, and they said they had "substantial concerns" about how the therapy is manufactured.

4. Costco joins primary care push

Illustration: Natalie Peeples/Axios

Costco is joining big retailers' push into primary care by offering members $29 telehealth visits, as well as lab testing and virtual mental health services, Axios' Adriel Bettelheim writes.

The big picture: It's part of a broad effort to use digital tools to create more customizable patient experiences that's also drawn the likes of Amazon, Walmart, CVS and Dollar General.

  • The retailers believe they're better positioned to tap into consumers' tastes — and frustrations with the traditional health system.

What's happening: Costco is teaming with the online platform Sesame to offer same-day $29 virtual primary care visits with no wait times.

  • A standard lab panel and consult will cost $72, while a virtual therapy visit will be $79. Costco members could start booking services on Monday in every state.
  • Sesame operates outside of insurance networks, catering to people with high-deductible plans who pay out of pocket for basic care and to the uninsured.

More here

5. Staffing crunch hit federal health facilities

Illustration: Gabriella Turrisi/Axios

A tight labor market, comparatively poor pay, COVID-19 requirements and a lengthy hiring process contributed to staffing shortages and decreased access to care at federal health care facilities during the pandemic, Axios' Maya Goldman writes on a federal report.

Why it matters: Officials must do more to ensure facilities are properly staffed during normal operations and strategically plan for future pandemics and other health emergencies, according to agency watchdogs on the Pandemic Response Accountability Committee.

Details: There were nursing shortages at around 9 in 10 Veterans Health Administration facilities and Department of Defense medical treatment facilities, as well as 69% of Federal Bureau of Prisons institutions in the study sample.

  • Each agency also reported physician shortages.
  • Additionally, there were shortages at 94% of nursing homes that accept Medicare and Medicaid funding — but unlike those other institutions aren't federally operated.

By the numbers: About 80% of federal inmates reported poor medical care from the Bureau of Prisons during COVID-19 lockdowns, compared to 41% before the pandemic.

  • Officials at DOD treatment facilities said the hiring process could take six months or longer.
  • One private health company posted a job this January with an annual salary of $81,120, which was $33,504 more than a similar job at a DOD health facility.

Read more

6. Catch up quick

✅ North Carolina's Medicaid expansion to 600,000 adults will now start Dec. 1, two months later than planned because of a budget fight. (Associated Press)

💊 Two pediatric cancer drugs are the latest to face shortages. (NBC News).

🩸 A new study found significant differences between the blood samples of patients with long COVID and those without. (Axios)

🩺 Two influential medical groups with Scripps Health are dropping their Medicare Advantage contracts. (MedPage Today)

Thanks for reading Axios Vitals, and to health care editor Jason Millman and copy editor Matt Piper. Please ask your friends and colleagues to sign up.