Friday Shorts: Telemed, home testing, cancer screening, AI, and digital nudges
February 14, 2025
1. Congress did not extend the safe harbor for offering telehealth with no out of pocket costs before deductibles
During the COVID-19 Pandemic, Congress allowed employer plans to provide coverage for telehealth care with limited or no cost sharing in high deductible health plans without jeopardizing the associated tax-advantaged Health Savings Accounts (HSAs). However, the last Congress failed to extend this safe harbor for plan years that begin on January 1, 2025 or later. The current Congress could retroactively reinstate this safe harbor, but prospects for that are uncertain.
Employers with HDHPs that have waived some or all cost sharing for telehealth visits should check with counsel to determine if they need to reinstate member cost sharing. Employers should also consider whether any point solutions offer virtual visits that fall outside of preventive care, which could also require cost sharing to maintain tax advantaged HSAs. If companies make changes in their coverage, they should communicate these fully with their members.
2. HPV at-home self-testing
The Food and Drug Administration (FDA) approved a self-swab for human papillomavirus (HPV) last year. This could replace pap smears or physician cervical swabs for cervical cancer screening for many women. However, the FDA approved this swab only when performed by women in a clinician’s office. Here’s a good reviewof how women are as effective at this swabbing as clinicians. I hope the FDA will approve this test for home use in the near future.
3. Transportation insecurity and lack of social support led to less cancer screening
Source: Pohl, et al JAMA Network Open January 30, 2025
JAMA Network Open published a study of survey and claims data for about 25,000 adults to demonstrate that those who have transportation insecurity or less social support are less likely to obtain evidence-based screening. Employers should be aware that those with more transportation challenges or lower social support are at higher risk for not receiving cancer screening.
4. Large Language Models and returning portal messages from adolescents
Source: Tse, et al JAMA Pedi January, 2025
Pediatricians at Stanford used a large language generative AI model to assess and propose answers to questions sent through the electronic health record portal from adolescents ages 12 to 17 or their parents. They found the LLM answers to be overall accurate and readable and two-thirds (67%) were judged to be “useful” by three reviewing pediatricians. This is promising as a way to address clinician “inbox burnout” and could bode well for human resources generative AI software to help members navigate health benefits. On the other hand, artificial intelligence accuracy and clinical usefulness will have to improve for this to represent a substantial move forward.
5. Digital nudges for flu shots
Influenza vaccines save lives -- especially among very young children and those with cardiovascular disease. Nonetheless, only a minority of those with known heart disease get influenza vaccines each year. JAMA Cardiologypublished a meta-analysis of three randomized clinical trials with almost 300,000 adults under age 65 performed in Denmark to use nudges to increase flu shot rates. Rates of flu shots in Denmark are substantially higher than rates of flu shots in the US.
All six “behaviorally informed” nudges in the form of letters sent electronically increased rates of flu shots between 38-50% and these results were statistically significant in each group. Overall, the rate of flu shots in those who received these letters was 42% higher than those who received usual care. This demonstrates that electronic messaging can be highly effective at increasing adherence to recommended vaccinations.