Weekend Update

What goes around comes around.  The New York Times reports this morning on a new trend among health insurers selling to individuals and small business — plans with narrow provider networks. Of course, in the 1990s health insurers pushed the managed care model featuring narrow networks and a primary care physician gatekeeper. The new model allows the patient to make his or her own health care choices among a smaller network of providers that the insurer presumably considers cost effective. The article indicates that larger employer have begun expressing interest in the approach. In the end it may be that only larger employer will have this option because the narrow network approach may run afoul of the Affordable Health Care Act’s requirement for qualified health plans operating in the health insurance exchanges beginning in 2014.

NCQA last week announced changes to next year’s HEDIS quality standards that can be used to measure the performance of  health plans.  OPM currently uses a subset of those standards with FEHB plans. OPM explained in its April 2010 call letter for 2011 benefit and rate proposals that

OPM plans to work with experts in the field to develop a refined set of performance measures that provide additional insights into plan quality. We will continue to endeavor to align our quality measurement requirements with existing NCQA processes wherever possible to reduce the burden on plans. Other large employers and purchasing coalitions have continually evolved their performance measurement requirements and the FEHB Program needs to do the same,

Last week the Pharmaceutical Research and Manufacturers of America (“Phrma”)  named John J. Castellani, formerly head of the Business Roundtable, to be its new President.

The FEHBlog discovered that on June 24, 2010, the Congressional Research Service published a report on Federal Employee Benefits and Same Sex Partnerships.