Mid-week update

The FEHBlog was surprised to read this FedSmith article which suggests that based on a 1978 law OPM does not have the authority to extend FEHB coverage to intermittent, seasonal, and temporary employees who meet the ACA’s standard for a full time employee. Assuming the accuracy of the description of the 1978 law, this would only be one of several FEHBA provisions that the ACA impliedly repealed. Go ahead and look in the statute books for 5 U.S.C. 8901 and you’ll see that family member is still defined as a spouse and child under age 22. Nobody blinked in 2010 and there was no reason to blink when OPM jacked up the eligible limit for child coverage to 26 and removed all financial dependency requirements. To the contrary the debate was over whether OPM should have waited until January 1, 2011, to make the change, which it appropriately did. In this case, the ACA’s employer shared responsibility mandate does require the eligibility change that OPM has proposed.

Kaiser Health News collects reports on major health insurers’ 2nd quarter 2014 earnings releases.  The Wall Street Journal and Modern Healthcare report on the earnings release from the major prescription benefits manager Express Scripts which suggest that the Medco acquisition a few years ago combined with the loss of United Healthcare’s business is dragging down earnings.

Ihealthbeat.com reports on a large healthcare consumer study which concludes that  “‘a single exposure of loyalty rewards
significantly influenced enrollment’ in [health plan] online health management
programs. However, they added that ‘additional strategies are required to maintain engagement.'”

Finally, Fierce Health Payer reports on a study which suggests three ways to improve collaboration between those two feuding parties — providers and payers.  The article suggests that payers should take the initiative to

1. Reimburse for the end-to-end population health management workflow — Instead of focusing on only closing care gaps or reducing utilization
rates, for example, payers should reimburse for the entire workflow so
that providers are more willing to invest in the sometimes pricey
resources needed to implement value-based programs.
2. Share as much data as possible –For example, as the publication previously reported, Aetna
shares its data with its provider partners, believing that the
information helps doctors and hospitals do a better job at a lower cost, FierceHealthPayer previously reported. But insurers
shouldn’t just dump data on providers and expect them to understand it;
instead, they should assist in analyzing and drawing specific
conclusions. On the flip side, providers that are collecting their own data, which
is often richer in patient care history than payers’ claims data,
should share this information with insurers. Then, payers and providers
can both use a more complete set of data to improve quality of care. and
3. Collaborate at the organization, rather than the individual practice level. 
 

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