Weekend Update

We have a big week ahead of us. The Federal Benefits Open Season starts tomorrow and will end on December 8. It will be interesting to see how many temporary, seasonal, and intermittent employees sign up for FEHBP coverage as a result of OPM’s rule implementing the ACA’s employer shared responsibility mandate.

Congress returns on Wednesday for its lame duck session. The continuing resolution funding the federal government expires on December 11.

The ACA health insurance marketplace open enrollment period begins on November 15 and runs until February 15, 2015. So we should hear alot about ACA premium changes this week. Last week, the ACA regulators issued FAQ XXII which puts the kibosh on tax free employer funding of employee coverage in the ACA marketplaces. Pre-ACA marketplace the IRS condoned the common practice of employers reimbursing their employees for individual health insurance premiums on a pre-tax basis. No more.  

The Wall Street Journal reported last week that the big prescription benefit manager (“PBM”) Express Scripts is considering ripping a page out of its major competitor CVS Health’s playbook by offering a no-sin pharmacy network. Express Scripts is considering creating a network of pharmacies that don’t sell tobacco or alcoholic beverages. The CVS no-sin network consists of pharmacies like CVS Health that don’t sell tobacco. Before long you won’t be able to buy a Twinkie at a pharmacy. But after all most sin product sales occur at the gas and liquor stores.

On a related note, the Motley Fool brings us up to date on the third large PBM Catamaran which is not quite in same league as CVS Health and Express Scripts but presumably it tries harder.

Finally the FEHBlog found good and bad news on efforts to solve the hospital readmission problem. Let’s start with the bad but not surprising news. Fierce Healthcare reported on an American Journal of Managed Care report concluding that hospitals cannot control the problem without primary care provider cooperation.

Researchers, led by Ariel Linden of the University of Michigan School of Public Health, analyzed more than 500 patients in two Oregon community hospitals. They gave half the patients an intervention featuring pre-discharge education and planning, post-discharge follow-up, an available hotline and “bridging” techniques such as daily symptom checks. Linden and his coauthor, Susan W. Butterworth, Ph.D., found no statistical difference in readmissions between the two groups after both 30-day and 90-day periods, although mortality was lower in the intervention group than the control group.

Neither of these hospitals could compel PCP cooperation with the intervention group and very little PCP cooperation with offered. How can a health plan help with this mess? The second Fierce Healthcare article offered some light at the end of this tunnel.

One extra day in the hospital cuts costs and significantly reduces the chance of the need to readmit Medicare patients within 30 days, a new study from Columbia Business School found.  That extra day slashed the risk of death for patients treated for pneumonia by 22 percent. Mortality for heart attack patients was cut by 7 percent, as were readmission rates, according to an announcement detailing the findings

Health plan utilization review programs should take note of this Colimbia study. 

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